John and Ringo had disc bulges but no back pain (image source)

Treat the man, not the scan…

We spend over $635 billion on chronic pain ever year. Billion.

A big reason why is because of our focus on medical Imaging, structural pathologies, and perception drugs.

Why is this bad?

Well the prescription drug thing is a topic for another day. But as far as imaging goes, it needs to be tailored to the patient.

"The finding that >50% of asymptomatic individuals 30–39 years of age have disk degeneration, height loss, or bulging suggests that even in young adults, degenerative changes may be incidental and not causally related to presenting symptoms. The results from this systematic review strongly suggest that when degenerative spine findings are incidentally seen (ie, as part of imaging for an indication other than pain or an incidental disk herniation at a level other than where a patient’s pain localizes), these findings should be considered as normal age-related changes rather than pathologic processes."

And specifically for the baby boomers...

"With a prevalence of degenerative findings of >90% in asymptomatic individuals 60 years of age or older, our study supports the hypothesis that degenerative changes observed on CT and MR imaging are often seen with normal aging."

That's not to say we should throw it out. It is very valuable when used appropriately. Sometimes imaging is necessary.

Example people that need imaging

someone rolled their ankle and has pain on their malleolus and inability to weight bear (x-ray to see if it's fractured)
a woman finds a lump in her breast (ct scan to see if it's cancer)
someone has bowel and bladder loss after shoveling snow and injuring their back (go to ER and get imaging and treatment)
Fell off a curb directly into the shoulder and have severe pain, inability to move it, and edema (x-ray for fracture)
someone with chronic hip pain, limited motion, severe morning stiffness, >60 years old, and failed conservative tx (x-ray to assess status of hip osteoarthritis)

Find a famous picture of a group and probably half of them will have bulging discs.