A common question is, “How do you rate impairment for someone who had a low back injury, usually minor trauma, and is subsequently found to have one or more bulging disc(s) on a lumbar MRI scan?”

There is no correlation between disc bulging, injury, and low back pain (LBP). Disc bulges are seen in asymptomatic adolescents and become more common with aging. What if a patient complained of headaches and was advised by a physician, “Of course you have headaches! You have gray hair. And the gray hair indicates you have an impairment.” The medical opinion rendered in such a scenario, analogous to LBP and disc bulging, would not be considered credible by any physician, and yet some physicians attribute back pain to “bulging discs.”

There are many symptoms for which we have etiologic theories,...

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