“I got to the point where I couldn’t pick up my grandchildren.”
That sentence has been said, in some version, in more spine consultations than anyone has counted.
If your back hurts but your leg does not, and your life has been quietly getting smaller because of it, this article is for you.
Read the Full Video Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The views expressed are intended to explore the full range of clinical considerations in spine care and do not constitute medical advice. Outcomes vary by patient and pain pattern. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
There is a kind of back pain that does not shoot down the leg, does not show up dramatically on imaging, and does not usually make it onto the list of urgent symptoms. And yet, slowly, it can take over a life.
Welcome to this Vertrae® 360 explainer. Today, we are looking at a deeply personal medical reality that is often misunderstood. If you feel like your world has been quietly shrinking because of your back, this one is for you.
Let’s talk about back pain that stays in the back. The medical community may refer to this as axial low back pain. It is its own distinct pattern. It can have its own unique causes, and it deserves the same careful evaluation as pain that radiates down the leg. It is real. It is common. And it is clinically meaningful.
This is not just a lesser version of leg pain. It is its own distinct reality. Think about what often happens when you go to the doctor. One of the first questions you may be asked is, “Does the pain shoot down your leg?” And if you say no, the absence of leg pain changes the diagnostic picture.
Without that radiating symptom acting like a bright sign pointing toward obvious nerve involvement, the medical evaluation has to look in different places. The pain could be coming from the discs, the small joints in the back, bone marrow signal changes near the disc, or even deep stabilizing muscles that have lost coordination. Not having leg pain does not mean nothing is wrong. It means we may need a different map to understand what is happening.
What is especially important is the disconnect in how this condition is often handled. Axial low back pain is one of the most commonly dismissed types of pain in modern medicine. On one hand, there is the medical chart. Patients are often told their imaging looks “mild” or “unremarkable.” They may be advised to live with it, try physical therapy, or give it more time.
But on the other hand, there is the patient’s reality. The pain may be severe. It may be life-shaping. It may be waking them up at 3 a.m. The visit often ends with a generic recommendation for physical therapy or time, leaving the patient feeling as if their pain was filed under “probably nothing serious” before they even finished talking.
To understand that frustration, listen to this patient quote: “Even my scoliosis has been dismissed by my doctors because it is too mild to cause the level of pain I experience.” That sentence says a lot. The patient is naming an actual finding on imaging, but also pointing to a gap between a clinical imaging report and the reality of everyday life.
And this distinction matters: “mild” describes the picture. It does not describe the experience.
Decades of research show that imaging findings in the spine do not always match how a person feels. An MRI shows anatomy. It does not fully capture what it feels like to wake up in severe pain in the middle of the night. It does not capture the activities that have quietly disappeared from someone’s routine.
And what patients lose to back-only pain is rarely captured on a medical chart. These are the unmeasured costs. It is the grandchild you stopped lifting — not because a doctor told you to, but because picking them up became a frightening calculation. It is the garden that went untended because bending over became too much. It is the Saturday round of golf left in the garage, the bag you walk past every time you pull the car in.
These losses do not fit neatly into a box on a medical intake form. And the pain does not only affect the individual. The entire family can quietly reorganize around something no one is clearly naming. Your spouse may start carrying the heavy things they never used to carry. They may ask how you slept before they ask about anything else. You may find yourself bracing a hand on the kitchen counter just to load the dishwasher, or doing mental math about how long you can stand at a family dinner. The pain can silently impact the whole household.
To understand what this means for patients, let’s look at the research. In 2014, a meta-synthesis published in BMC Musculoskeletal Disorders pulled together 42 qualitative studies. Researchers looked at people living with low back pain to understand what they experience and what they want from the healthcare system.
The findings reflect what many patients have felt for years: alongside any physical treatment that may help, people with chronic back pain want to be believed. They want their experience validated. That validation is not just a polite gesture. It is the foundation for everything that comes next.
If a patient feels dismissed because their MRI said “mild,” the entire treatment plan is built on shaky ground. But when a doctor starts by truly acknowledging the impact of the pain, real progress can begin.
That brings us to a different kind of spine care experience. At Vertrae® in Miamisburg, Ohio, Dr. Kamal Woods is a dual fellowship-trained neurosurgeon and spine surgeon specializing exclusively in minimally invasive spine surgery. He leads Vertrae®, a comprehensive, spine-only center that approaches axial low back pain differently.
At Vertrae®, axial low back pain is treated as what it is: real, common, and clinically meaningful. Dr. Woods has built his practice around a specific philosophy: the diagnostic process is not just about checking boxes. The patient’s story matters. The exam matters. The imaging matters. And the life the patient has lost matters.
At Vertrae®, the patient’s story is treated as a vital part of the diagnostic process, not just a warm-up conversation before looking at an MRI. This level of validation directly shapes the treatment plan. The plan is built around the patient’s actual life goals: lifting a grandchild again, returning to the garden, or putting that Saturday morning round of golf back on the calendar.
At Vertrae®, these personal goals are not extras or “nice to haves.” They are the outcomes the medical plan is designed to support. A thorough evaluation is not always about finding something to immediately fix with surgery. Sometimes it is about being heard for the first time in a long time.
The best path forward may be a structured rehabilitation plan, a deeper diagnostic evaluation, a targeted procedure, or a thoughtful watch-and-reassess approach. But the beginning of healing is sitting down with someone who listens to your story.
The crucial point is this: you are not imagining it. The pain is real. The losses are real. And an unremarkable imaging report does not mean your experience is unremarkable.
Ask yourself: are you ready to stop letting the word “mild” define the boundaries of your life? If your back pain has been quietly taking things away from you, a conversation at Vertrae® in Miamisburg, Ohio may be a place to begin.
Quick Answer:
Back-only pain — pain that stays in the back and does not travel down the leg — is real, common, and clinically meaningful. It is not a lesser version of leg pain. It can quietly reshape a life: the grandchildren you cannot lift, the garden that goes untended, the activities that quietly disappear. The losses are real, even when the imaging looks unremarkable. You are not imagining it. And you are not alone.
It is not the kind of detail that fits cleanly on a chart. It is also, often, the most important thing the patient came to say.
If your back pain stays in your back — if it does not radiate down your leg, if there is no shooting nerve symptom, if the imaging report came back with words like “mild” or “unremarkable” — you may have been told, more than once, that there is not much wrong. Maybe directly. Maybe by the way the visit moved on quickly to the next thing.
And yet here you are. The back hurts. The grandchildren are getting heavier. The golf clubs have not been moved in a year. The garden has not been weeded since spring. The shape of your life is not what it was.
This article is for that experience.
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“I got to the point where I couldn’t pick up my grandchildren.” |
Back-only pain is real, common, and clinically meaningful
It is worth saying plainly. Pain that stays in the back — sometimes called axial low back pain — is not a lesser version of pain that travels down a leg. It is its own pattern. It has its own causes. It deserves the same careful evaluation.
It is also extremely common. Most people with low back pain do not have radiating leg symptoms. The presence of leg pain often signals nerve involvement and tends to direct the work-up toward the nerves. The absence of leg pain does not mean nothing is wrong. It means the picture is different — and the work-up has to look in different places.
Imaging is part of that picture, but only part. Decades of research have shown that imaging findings in the spine are common in people who feel completely fine, and that the same imaging findings can mean very different things in different people (Brinjikji et al., 2015). The MRI shows the anatomy. It does not show how the pain feels at three in the morning. It does not show what activities have quietly disappeared. It does not show what the patient is trying to get back to.
So when an imaging report says “mild,” it is describing the picture, not the experience. The experience belongs to you.
Why this kind of pain often gets dismissed
There is a particular pattern in healthcare that anyone with axial back pain has probably encountered.
The visit is short. The questions move fast. The first thing the doctor asks is whether the pain shoots down a leg. The patient says no. From that point forward, the conversation seems to lose some of its urgency. The imaging gets ordered, and when it comes back without a dramatic finding, the visit ends with some version of “this should improve with time” or “try physical therapy” or “there is nothing structural to fix.”
None of that is necessarily wrong, in the moment. Time and physical therapy do help many people. But it can leave the patient with the unmistakable feeling that what they came to say did not quite land. That the pain was filed under “probably nothing serious” before they had finished describing it.
One patient summed it up this way: “Even my scoliosis has been dismissed by my doctors because it is too mild to cause the level of pain I experience.”
That sentence is doing a lot of work. The patient is naming an actual finding on imaging. They are also naming the gap — the gap between what the imaging says is mild and what their life feels like is not.
Both can be true. The imaging can be mild. The pain can be life-reshaping. Holding both of those at the same time is what good spine care has to do.
What back-only pain quietly takes
This is the part of the visit that often does not happen — the part where someone asks what the pain has actually cost.
It is the grandchild you stopped lifting. Not because anyone told you to stop. Because you tried, one day, and felt something that scared you, and you have not tried since. Because picking them up has become a calculation you do not want to make in front of them.
It is the garden. The way the back row has gone to seed because bending over became too much. The tomato plants that did not get staked this year. The flower bed you used to tend on Saturdays — still there, but quieter, less yours.
It is the round of golf left in the garage. The bag you walk past every time you pull the car in. The Saturday morning that used to start at the first tee and now starts on the couch. “My golf clubs are sitting in the garage unused” — a sentence that has carried more grief, in more consultations, than its words suggest.
It is the hike that has not been on the calendar for two summers. The walk around the lake that has gotten shorter. The vacation that did not happen because the drive felt impossible.
It is your spouse. The way they have started carrying things they did not used to carry. The way they ask about your sleep before they ask about anything else. The way the family has reorganized itself, quietly, around something no one is naming.
It is sleep. Three a.m., the world too still, the rolling-over a project. The way mornings come thick with whatever the body is announcing that day.
It is the small things you do not say out loud. The way you brace your hand on the kitchen counter when you bend toward the dishwasher. The way you choose the chair you sit in by where the support is. The way you have started doing math about how long you can stand at the grocery store, the family dinner, the wedding.
None of that is dramatic enough for an MRI report. All of it is your life.
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None of that is dramatic enough for an MRI report. All of it is your life. |
Snippet — What back-only pain takes
Pain that stays in the back can quietly reshape a life: the grandchildren a patient cannot lift, the garden that goes untended, the round of golf abandoned, the hike off the calendar, the way a spouse and family quietly reorganize around something no one names. The losses are real, even when imaging looks unremarkable.
What patients with chronic back pain say they want
In 2014, researchers in the United Kingdom published a meta-synthesis in BMC Musculoskeletal Disorders that pulled together forty-two qualitative studies of people living with low back pain (Froud et al., 2014). The aim was simple: to understand what patients themselves describe about the impact of pain on their lives, and what they are looking for from the healthcare system.
The findings should not be surprising, but they often are.
Patients want to be able to do the things that matter to them. They want to engage in meaningful activities. They want to keep showing up as themselves — as the parent, the grandparent, the spouse, the worker, the friend, the gardener, the golfer, the hiker.
And alongside any treatment that may help, what they want most from the healthcare encounter is to be believed. To have their experiences and identity validated. To have the realness of the pain acknowledged — not as a soft gesture, but as a foundation for everything that comes next.
That is not a small thing. That is the thing.
What patients want most is to be believed — to have the realness of the pain acknowledged as a foundation for everything that comes next. |
What back-only pain may be telling us
This blog is not the place for a deep dive into what is happening anatomically when back pain stays in the back. Other posts in this series will go further. But it is worth a few sentences.
Pain that stays axial — in the back, sometimes radiating into the buttocks but not into the leg — can come from many sources. It can come from the disc. It can come from the small joints in the back. It can come from the bone-marrow signal changes near the disc that are sometimes called Modic changes. It can come from the deep stabilizing muscles that have lost their normal coordination after an old injury. It can come from a combination of those.
Each of those has its own evaluation. Some of those have specific treatments that did not exist, or were not widely available, ten or fifteen years ago. None of that is the focus of this post — the focus is the experience. But it is worth knowing that “there is nothing dramatic on the imaging” and “there is nothing to do” are not the same sentence.
At Vertrae®, this kind of pain is taken seriously
Dr. Kamal Woods is a dual fellowship–trained neurosurgeon and spine surgeon specializing exclusively in minimally invasive spine surgery, with advanced training that includes Cedars-Sinai. Vertrae®, a comprehensive, spine-only center led by Dr. Woods, serves patients in Miamisburg, Dayton, and across Southwest Ohio.
At Vertrae®, axial low back pain is treated as what it is: real, common, and clinically meaningful. The story matters. The exam matters. The imaging matters. The losses matter. So does what the patient is trying to get back to.
That last part is not a soft addition. It is part of how the plan gets built. The grandchild you want to be able to lift. The round of golf you want to put back on the calendar. The night of unbroken sleep. Those are not extras. They are the goals the plan is supposed to serve.
And whether the path forward is a structured rehabilitation plan, a more careful diagnostic look, a procedure for a carefully selected patient, or a thoughtful watch-and-reassess, the conversation begins with the patient being heard.
If you have been reading this and recognizing yourself
If you have been reading this and recognizing yourself — the grandchildren, the garden, the golf, the way the visit ended too quickly the last time — we want to say something simple.
You are not imagining it. The pain is real. The losses are real. The fact that an imaging report came back unremarkable does not mean the experience is unremarkable. It does not mean the visit is over before it has begun.
This kind of back pain is one of the most common things a spine specialist sees. It is also one of the things most easily misread by a system in a hurry. There are real options. There are real conversations to be had. There is a path forward that starts with someone actually listening to the story you came in to tell.
Key Takeaway
Lumbar instability treatment is not a single protocol — it is a spectrum of options matched to the individual patient’s clinical profile, goals, activity level, and surgical history. The spectrum at Vertrae® includes: stability-directed physical therapy targeting the deep stabilizing muscles; ReActiv8® restorative neurostimulation for multifidus dysfunction in non-surgical candidates; BVNA for vertebrogenic endplate pain with Modic changes; interventional procedures as pain management support; and robotic-assisted MIS-TLIF using the Mazor X™ system for documented instability requiring surgical stabilization. Two patients with identical imaging may need different approaches — because the patient’s goals and biology are part of the clinical equation. At Vertrae® in Dayton, Dr. Kamal Woods evaluates every patient personally with the full toolkit available, ensuring the recommendation follows the individual — not just the diagnosis.
Listen to This Topic: When Back-Only Pain Quietly Takes Over a Life
Prefer to listen? This episode explores what happens when back pain that does not travel down the leg quietly reshapes a life — the canceled trips, the unlifted grandchildren, the garden that has gotten smaller. In a clear, conversational format, we discuss why this kind of pain often goes unacknowledged, what patients say they want most from their care, and what a careful, listening-first evaluation can look like.
Read the Full Podcast Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The conversational format is designed to explore concepts and tradeoffs, not to provide medical advice or apply to any individual patient. Outcomes vary by patient, pain pattern, technology used, and study population, and findings from one clinical trial may not generalize to every situation. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
Speaker 1:
“I got to the point where I couldn’t pick up my grandchildren.”
Let’s pause for a second and let the weight of that statement sit in the air.
Speaker 2:
It is heavy. It really is.
Welcome to this deep dive. That sentence gets spoken in spine clinics across the country every day. But what happens when you say that to a doctor, they look at your MRI, shrug, and say, “Well, the scan looks fine to me”?
Speaker 1:
Right. It is incredibly frustrating.
Today, we are doing a deep dive into a very specific and often isolating kind of back pain: the kind that stays right there in your back. It does not shoot down your leg, but quietly, day by day, it shrinks your world.
Speaker 2:
It really is an isolating experience, because you have profound daily suffering, but the clinical tools that our medical system often relies on keep suggesting that nothing is severely wrong.
Our sources today are centered around the clinical and emotional realities of what is called axial back pain, or back-only pain. We are also drawing from the clinical philosophy of Dr. Kamal Woods, a dual fellowship-trained neurosurgeon and spine surgeon with advanced training, including Cedars-Sinai.
Speaker 1:
And he leads Vertrae® in Ohio.
Speaker 2:
Exactly. Dr. Woods leads Vertrae® in Miamisburg, Ohio, serving Dayton, Centerville, Kettering, Beavercreek, and the broader Southwest Ohio region. His approach fundamentally challenges how modern medicine looks at this type of pain, which is exactly what we want to unpack today.
Speaker 1:
So the roadmap for this deep dive is about the gap between two different realities. We are going to explore the disconnect between what an MRI shows and what daily life actually feels like. We will talk about the quiet losses that result from that gap. And then we will look at why having your story believed is not just good bedside manner. It is a critical diagnostic tool.
Speaker 2:
Right. Because to understand the toll this takes, we first need to look at why axial back pain is so often dismissed in a typical medical setting. A rushed doctor’s visit can easily miss the point of this specific condition.
Speaker 1:
Let’s put the listener in that exam room for a second.
You go in, and the visit is scheduled for maybe 15 minutes, if you are lucky. The questions are coming quickly, and one of the first things the doctor asks is, “Does the pain shoot down your leg?”
Speaker 2:
The classic question.
Speaker 1:
And you answer, “No, it just stays in my lower back.” Then you can almost feel the urgency leave the room. The doctor relaxes. The pen goes down.
Speaker 2:
It is a major pivot in the appointment, because historically, the medical system has been trained to look closely for nerve compression.
If pain shoots down the leg, that may suggest sciatica. It can signal that a disc or bone spur is irritating or compressing a nerve root. That is a clearer mechanical problem that clinicians know how to evaluate and, in selected cases, treat.
But the flawed leap is assuming that the absence of leg pain means nothing serious is wrong.
Speaker 1:
Which brings us to the frustration of the “mild” diagnosis.
The doctor may order the MRI to check the boxes, and the report comes back with phrases like “mild degenerative disc disease” or “unremarkable.”
Speaker 2:
“Unremarkable” can be such a painful word to hear when you are hurting.
Speaker 1:
Absolutely. So the visit may end quickly. You get a suggestion to try physical therapy, and then you walk out to your car feeling like you have been filed away as “probably nothing serious.”
And yet, you are standing in the parking lot trying to figure out how to turn the steering wheel without gasping in pain.
Speaker 2:
It is an incredibly alienating moment. Your lived experience is telling you that something is deeply wrong, but a piece of paper is telling the medical system that you are basically fine.
Speaker 1:
I have been trying to wrap my head around that disconnect, and I think part of the problem is that we treat an MRI like it is an all-knowing truth teller. But it is really more like weather radar. It can show anatomical “clouds” in the area, but it cannot tell you whether the rain is flooding your living room at 3 a.m.
Speaker 2:
That is a helpful analogy.
Speaker 1:
Or think about your car’s suspension system. An MRI is like a mechanic taking a high-resolution photograph of your car parked in a garage. In the photo, the car looks fine. The wheels are attached, the bumper is not dented, and everything appears normal.
But what the photograph cannot show is that the shock absorbers are worn out, the alignment is off, and if you drive that car at 60 miles an hour, it shakes so badly you can barely hold the steering wheel.
Speaker 2:
That is exactly the point. The structural picture may look relatively calm, but the functional reality can be very different.
The MRI describes static anatomy. It does not fully describe the dynamic experience of moving through the world.
And there is research that challenges how much we rely on MRI findings alone. In 2015, Brinjikji and colleagues published a systematic literature review looking at imaging features of spinal degeneration in asymptomatic populations.
Speaker 1:
Meaning people walking around with no back pain.
Speaker 2:
Correct. No pain at all. Researchers looked at MRI findings in thousands of people without back pain, and the results were eye-opening.
They found that findings often labeled “mild” or “moderate” on an MRI — things like disc degeneration, disc bulges, and facet changes — are extremely common in people who feel completely fine. By age 50, a large majority of pain-free people have disc degeneration on MRI.
Speaker 1:
So many people have MRI findings that look imperfect, but they are living pain-free lives.
Speaker 2:
Exactly. As we age, some degree of spinal change is very common. It does not automatically equal pain.
And the reverse is also true: the absence of a dramatic abnormality on a scan does not mean the absence of pain.
When a radiologist writes “mild” on your report, it does not mean your pain is mild. It means the static anatomical picture does not look severe.
Speaker 1:
There is a quote from the sources we reviewed that speaks directly to this gap. A patient said, “Even my scoliosis has been dismissed by my doctors because it is too mild to cause the level of pain I experience.”
Speaker 2:
That patient is pointing directly to the flaw in the system. They have a physical finding — scoliosis, a curvature of the spine — but the doctor may be looking at the degree of the curve, comparing it to a textbook, and saying, “That should not hurt that much.”
Speaker 1:
It is treating the textbook instead of treating the patient sitting in front of you.
Speaker 2:
Exactly. It can make the patient feel like an unreliable narrator of their own life.
Speaker 1:
Which forces the question: if the MRI does not fully map the reality of axial back pain, what does that reality actually look like?
Because it is not always a jagged bone on an X-ray. It is often a quiet ecosystem of losses.
Speaker 2:
Yes. It is the part of the medical visit that often never makes it into the electronic chart — the part where a physician slows down and asks the patient to name what pain has cost them over the last year.
Speaker 1:
We need to slow down here, because this is where the truth of the condition often lives.
For someone listening, maybe it is the garden. Maybe the back row of the garden went to seed this summer because bending over to pull weeds became too painful. Maybe the tomato plants did not get staked. Maybe the flower bed you used to tend every Saturday morning is still there in the yard, but it feels less yours now.
Speaker 2:
Or maybe it is the golf clubs left in the garage. The bag you walk past every time you pull the car in. The Saturday morning that used to start on the first tee with friends now starts on the couch with a heating pad.
One of the patient quotes in the source material was simply, “My golf clubs are sitting in the garage unused.”
Speaker 1:
That is not just a logistical statement. That is grief. It is the loss of an identity.
Speaker 2:
Exactly. And it may also be the hikes that have been off the calendar for two summers, the family vacations that were skipped because sitting in the car for a four-hour drive felt impossible, or the nights when rolling over in bed becomes a project that wakes you up completely.
Speaker 1:
Beyond the major events and hobbies, there are the quiet calculations. The micro-adjustments you make throughout the day.
It is the way you brace your hand on the kitchen counter when you bend toward the dishwasher. It is the way you scan a restaurant or meeting room to choose a chair based on lumbar support or how difficult it will be to stand up later.
Speaker 2:
Exactly. You are constantly doing this silent math.
How long can I stand at the grocery store before my lower back locks up? How long can I stand at a family dinner or wedding reception before I need to find a wall to lean against?
And that math ripples outward. It creates a gravitational shift in the family.
Speaker 1:
The whole household quietly reorganizes itself around the unspoken reality of pain.
Your spouse may start carrying the laundry basket or heavy groceries — things they did not use to carry. They may wake up and ask, “How did you sleep?” before asking about anything else, because your sleep can shape the whole day.
Speaker 2:
What strikes me as one of the most difficult parts is the self-limitation.
Speaker 1:
What do you mean?
Speaker 2:
No doctor necessarily sat you down and told you to stop picking up your grandchild. No doctor wrote a prescription that said, “Stop playing golf.”
You may have tried it one day, felt something sharp and frightening in your spine, and made a quiet internal decision not to try again.
Speaker 1:
You self-limit out of fear.
Speaker 2:
Exactly. And none of that fits on an MRI report. But it may become one of the defining features of your life.
That is one of the tragedies of axial back pain in a rushed healthcare system. The losses can be profound, but they are often invisible to the clinical tools we rely on.
Speaker 1:
I struggle with this next part, though.
The sources say that one of the most important things patients want is to be believed. But if I take my car to the mechanic, I do not just want the mechanic to validate my feelings about the broken suspension. I want them to plug it into a computer, find the broken part, and fix it.
So why is the spine different? Why is belief so central?
Speaker 2:
That is a valid question, but it assumes the human body is as straightforward as a mechanical system. And it is not.
In 2014, Froud and colleagues published a meta-synthesis in BMC Musculoskeletal Disorders. They reviewed 42 qualitative studies of people living with chronic low back pain. Instead of focusing only on pain scores, they looked at patient experiences and what people actually wanted from healthcare encounters.
They found that patients wanted to return to meaningful activities and maintain their identities as golfers, gardeners, workers, parents, or grandparents. But alongside any physical treatment, a fundamental need was to be believed — to have the realness of their pain acknowledged.
Speaker 1:
But is that just good bedside manner?
Speaker 2:
It is more than that.
We often treat being believed as a soft skill, like a nicety. But in axial back pain, being believed can be the clinical foundation for everything that follows.
Pain is not a leaking pipe you can always find with a flashlight. Pain is a complex, often invisible output of the nervous system. If a physician does not believe the severity of the patient’s lived experience, they may stop looking. The moment the MRI comes back “mild,” the diagnostic process can end too early.
Speaker 1:
That makes sense. If the clinician assumes the pain is mild, they may assume the workup is over.
Speaker 2:
Exactly.
But if the clinician believes the patient’s pain is severe, even when the scan looks relatively calm, then they keep asking better questions. They look for what the MRI might not fully explain.
Speaker 1:
So what should they look for? What are the biological mechanisms an MRI may miss or understate?
Speaker 2:
This is where we get into the micromechanics of the spine.
Axial back pain — pain without leg symptoms — can still have very real structural sources. No leg pain does not mean no structural issue.
For example, consider the facet joints. These are the small hinge-like joints at the back of the spine that help guide motion and limit excessive twisting.
Speaker 1:
Like the hinges on a heavy door.
Speaker 2:
Exactly. When a spinal disc loses even a small amount of height from age or injury, those joints may take on more load than they were designed to handle. They can become irritated, arthritic, and painful.
An MRI might note “mild facet hypertrophy,” but functionally, when you lean back, twist, or stand too long, those joints may be producing significant pain.
Speaker 1:
So the MRI sees a slightly thickened hinge, but the nervous system feels a fire alarm.
Speaker 2:
Exactly.
Another example is the deep stabilizing muscles, including the multifidus muscles. Think of them like small but vital support cables for the spine. After a back injury or prolonged pain, these muscles can lose normal coordination. They may stop firing at the right time, which can leave the spine less stable during movement.
An MRI may show the muscle structure, but it cannot fully capture timing, coordination, or how the muscle behaves during real-life movement.
Speaker 1:
Because it is a static image.
Speaker 2:
Exactly. The scan may look acceptable, but the back may still feel unstable when you reach for a coffee mug, load the dishwasher, or stand in one place too long.
Speaker 1:
What about those bone marrow changes the sources mention? Modic changes?
Speaker 2:
Yes, Modic changes.
The endplate is the boundary between the spinal bone and the disc. In some patients, that area can become irritated and inflamed. MRI may show bone marrow signal changes near the disc, which are called Modic changes.
In some cases, those changes may be associated with vertebrogenic pain — pain that can originate near the area where the disc meets the vertebral bone.
Speaker 1:
And a hurried doctor might dismiss that as normal wear and tear.
Speaker 2:
They might. But a clinician who believes the severity of the patient’s pain may look more carefully and ask whether that finding fits the patient’s symptoms.
That is the point: when imaging says “nothing dramatic,” that is not the same thing as “nothing to do.”
Speaker 1:
Belief shapes the diagnostic workup.
Speaker 2:
Exactly. If the doctor believes the patient, that belief can drive a more complete evaluation — the facet joints, the stabilizing muscles, the possibility of Modic changes, the movement exam, and the way symptoms behave in real life.
Speaker 1:
Which brings us to how this works in practice.
This framework — refusing to rely only on the scan, looking into the mechanisms of axial pain, and starting with belief — is central to the philosophy of Dr. Kamal Woods and the team at Vertrae®.
At Vertrae.com, patients can request a consultation and see what this kind of evaluation looks like in practice.
Speaker 2:
A practice that understands these nuances knows that listening to the patient’s story is not just a therapy session. It is gathering vital diagnostic data.
Speaker 1:
So story is data.
Speaker 2:
Exactly. If we know that mild imaging can still coexist with severe pain, then one of the only ways to understand the true impact of the condition is to listen to what the patient has lost.
Speaker 1:
So if belief and listening are the foundations of good spine care, what should that feel like for the listener sitting in a consultation room?
What should they expect from a doctor who understands this?
Speaker 2:
It should feel like rebuilding the medical plan from the ground up, with the patient at the center.
A thorough consultation takes the narrative seriously. The physical exam matters. The imaging matters. But the losses matter too, because they help direct the treatment goals.
The source material refers to this as using goals as medical strategy, which is a powerful reframing of healthcare.
Speaker 1:
It completely changes the traditional doctor-patient relationship.
In a standard visit, the goal may feel like “fix the MRI.” In a more patient-centered visit, the goal is the grandchild you want to lift without fear, the round of golf you want to play again, or the full night of sleep where rolling over is not a chore.
Speaker 2:
Exactly. Those are not small details you mention while the doctor takes notes. They are tangible metrics of success that the medical plan should serve.
If treatment does not help you get back to the garden, then treatment has not fully worked — regardless of what the follow-up image says.
Speaker 1:
And this is why we keep bringing up Dr. Kamal Woods and the team at Vertrae® in Miamisburg, serving Dayton, Centerville, Kettering, Beavercreek, and Southwest Ohio.
Their philosophy recognizes that the path forward for axial back pain cannot be generic.
Speaker 2:
Right. It is not simply a photocopied physical therapy routine handed to every patient on the way out the door.
The right path may involve a structured rehabilitation plan to retrain stabilizing muscles, a deeper diagnostic evaluation using targeted blocks to identify a pain source, a specific minimally invasive procedure for a carefully selected patient, or even thoughtful watchful waiting.
But every path begins with the patient being heard. The doctor and patient have to agree on what they are trying to win back.
Speaker 1:
It is treating the patient as the expert on their own life.
If you have been listening today and recognizing yourself in the garden that went to seed, the golf clubs in the garage, or the moment you look at your grandchild and do that quiet calculation in your head, we want to say something simple:
You are not imagining it.
Speaker 2:
The pain is real. The losses are real.
The fact that an MRI report came back saying “unremarkable” does not mean your experience is unremarkable.
The science supports you. Spine anatomy and pain science both show that severe pain can exist without a catastrophic-looking scan.
Speaker 1:
We want to end this deep dive with permission, not a medical directive.
If your back pain stays in your back and does not show up dramatically on a scan, you are still allowed to be heard. You are allowed to take up the doctor’s time. You are allowed to walk into your next consultation, perhaps at Vertrae.com, and bring a list of the things you have quietly stopped doing.
You do not have to apologize for a scan that does not match your suffering.
Speaker 2:
That permission matters, because axial back pain is one of the most common conditions a spine specialist sees. But it is also one of the conditions most easily misread by a healthcare system that is often in a hurry to find a simple surgical target.
You have the right to seek care that slows down and looks at the whole picture.
Speaker 1:
I want to leave you with a thought for the rest of your day.
Think about the quiet math you have been doing in your own life — even just today.
What is one activity you have slowly stopped doing without saying it out loud?
Speaker 2:
Maybe you stopped tending the back row of the garden. Maybe you stopped picking up your grandchild.
What would it feel like to finally walk into a room, say that out loud to a medical professional, and have the person sitting across from you simply say, “I believe you”?
Ready to Understand What Your Options Actually Are? Request an Evaluation at Vertrae®
If your back pain has quietly taken pieces of your life and you are tired of the pieces getting smaller, a careful evaluation may be worth a conversation. Not because surgery is the answer. Because being heard is the beginning.
No referral required. No commitment to any procedure from the evaluation.
Serving: Dayton • Miamisburg • Centerville • Kettering • Beavercreek • Springboro • West Chester • Cincinnati • Southwest Ohio
Vertrae® Surgery Center: Spine-exclusive outpatient facility • same-day discharge • no general hospital environment
Dr. Kamal Woods, MD, MBA: Dual fellowship-trained neurosurgeon • Cedars-Sinai trained • Mazor X™ robotic-assisted surgery • exclusively minimally invasive spin
→ Visit vertrae.com or call to request your MotionFirst™ evaluation today.
Frequently Asked Questions
Why is my back pain not going down my leg — is that good or bad?
It is just different. Back-only pain — sometimes called axial low back pain — is not a lesser version of leg pain. It is its own pattern, with its own possible causes and its own evaluation. The absence of leg pain does not mean nothing is wrong. It means the picture is different.
My MRI says “mild” but my pain feels severe. What does that mean?
It can mean that the imaging and the experience are telling different parts of the story. Imaging shows anatomy; it does not show how the pain feels or what it has cost. Research has long shown that imaging findings do not always match symptoms. Mild on the report does not mean mild in your life.
I feel like my back pain has been dismissed by doctors. Is that common?
Yes. Many patients with back-only pain describe feeling that the visit moved on too quickly once leg pain was ruled out. That experience is one of the most common in spine care. A meta-synthesis of patient experiences has found that what patients most want is to be believed.
My back pain has stopped me from doing things I love — is that just how it is now?
Not necessarily. Activities lost to back pain — picking up grandchildren, gardening, golf, hiking — are part of the clinical picture, not extras. A careful evaluation looks at what the pain has cost and what the patient is trying to get back to. Those goals are part of how the plan is built.
What does “axial” back pain mean?
Axial back pain is pain that stays in the back, without radiating down a leg. It may go into the buttocks but not below the knee. It is one of the most common patterns of back pain and has many possible causes — the disc, the small joints in the back, the deep stabilizing muscles, or a combination.
What should I do if I feel like no one has really listened?
Consider a focused spine evaluation that begins with the story, not just the imaging report. Bring a list of what makes the pain better or worse, what activities have been lost, and what you most want to get back to. The right evaluation should feel like a real conversation, not a brief stop on the way to a generic plan.
References (APA 7th Edition)
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
Froud, R., Patterson, S., Eldridge, S., Seale, C., Pincus, T., Rajendran, D., Fossum, C., & Underwood, M. (2014). A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskeletal Disorders, 15, 50. https://doi.org/10.1186/1471-2474-15-50
