Still a smidge of joint space between the ball and socket.
BUT, nowhere near as bad as some.

One of the four men from Newsletter #025 had lost all his joint space.
AND there was some bone collapse. Really bad..

Amanda’s x-ray film still supported hip replacement.

BUT I needed to be more certain. So, let's rule out the other things...


Magnetic Resonance Imaging (MRI)

A Nobel Prize winning innovation.
Over my career MRI's provided a step-change in diagnostic precision.

MRI can help rule out a trapped nerve in the back. A quick explainer on MRI...

Simply put, the human body is a big bag of cells and water, H­20.
MRI oscillates a powerful magnetic field back and forth across that bag.

To keep your bank cards working, leave them outside the scanner!

Each hydrogen atom of our H­20 gets an energetic push. Like a toddler on a swing.
Those excited toddler hydrogen atoms kick back.
Releasing radio frequency photons.

The number of photons depends on the amount of water
How much water there is in any particular human tissue.

Radio detectors pick up the signal.
Powerful computers build a 3D picture of H20 density.
Different human tissues shine in different shades of grey…


Inflamed Watery Tissue Shines Bright

The discs in Amanda’s lower spine are dehydrated.
They lack water. Are darker grey. And look worn.

As the disc dehydrates, it squishes down. Like a deflated tyre.
That loads the joints at the back of the back differently. The facet joints.
These joints inflame, swell and wear out.

Facet joints shine bright on the scan.
Inflammation. The 'itis' in osteoarthritis.

And like a donut being squashed, the disc can bulge or lose its filling altogether.
A prolapse or ‘slipped disc’. Or more correctly a disc protrusion...



Compressed nerve roots fire off pain signals.
Each nerve root supplies a strip of skin down the leg...

And the brain can’t tell the difference...


More compression leads to numb skin + weak muscles.

This all sounds terrible.
BUT those MRI findings are not that unusual.

Take someone randomly off the street and MRI their back.
Most will show up an abnormality.

Magnets detect water content. The MRI films sound like a blurry mess, right?

Nope...

The level of detail on MRI scans in 2024 is quite extraordinary.
Detail down to millimetre size blood vessels is seen.
MRI is very sensitive.

If there's a problem, MRI will pick it up.
BUT BEWARE:


Most people have a degree of wear and tear in their lower back.
Wear and tear that may or may not be causing problems.

No one is MRI-ing my back.
Who knows what they’ll find..!

However, Amanda WAS in pain. And compressed L5 and S1 nerve roots matched:

• Her calf pain
• Her numbness (outside of her calf)
• Her ⬇ ankle reflex
• Her weakness (pushing down with her foot).

Check out the picture above. L5 and S1...


Clinic time is spent matching the story + examination to the MRI scan.

So, Amanda has a...

POSITIVE hip joint x-ray film +
POSITIVE MRI scan.

AND the muscle is still in play.

Nothing ruled out. Hmmm...


So, what next?

Remember in Newsletter #017 I wrote ‘hold that joint injection in your back pocket’.

Well, this is where injection come into its own…

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So, generally speaking: AVOID injections.

BUT next week I'll run through how they helped Amanda.

I've then got in mind to cover off the real world outcomes of excess bodyweight.

AND then to write a slightly controversial newsletter about operating through a thick fat layer. Spoiler alert: it's challenging 😔
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Meantime if you know anyone, or anyone you know who knows anyone, with joint pain forward this email onto them.

And if someone's forwarded this to you, please join our weekly conversation about doing more with less hip and knee pain. You're very welcome along.

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Good luck, and see you next week :)