Have you been to multiple hospitals but still suffer from pain that won’t go away?

Many people live with chronic pain or numbness for years, only to be told it is simply “due to age” or “in your head” and must endure pain each day because imaging tests showed no clear cause.

ILC Diagnosis does not attribute pain to just a single cause. Instead, it is a method that unravels a complex web of overlapping factors—such as disc degeneration, spinal curvature, and joint inflammation—to see the complete picture of your symptoms.

These factors do not exist in isolation. They influence one another.

That is why treating only one finding often fails to improve symptoms—because other contributing factors remain untreated.

The ILC Diagnosis evaluates these elements comprehensively to clarify the full picture behind your symptoms.

The ILC Diagnosis reveals where pain truly originates, including causes that conventional imaging alone cannot detect.

• Specific low back pain: 15%
  → The cause can be identified on imaging
  → Common examples:
  • Lumbar disc herniation
  • Lumbar spinal canal stenosis
  • Spondylolisthesis
  • Compression fractures
  • Infection
• Non-specific low back pain: 85%
  → No clear cause identifiable on MRI or X-ray

Source: Ministry of Health, Labor and Welfare (Japan):　https://www.mhlw.go.jp/new-info/kobetu/roudou/gyousei/anzen/dl/1911-1_2d_0001.pdf (article in Japanese)

Low back pain is categorized into non-specific low back pain (85%), which is difficult to distinguish using imaging tests like MRI, and specific low back pain (15%), where the cause can be identified, such as disc herniation or spinal canal stenosis.
The ILC diagnosis analyzes these types of low back pain from multiple angles, in addition to standard MRI diagnosis.
For specific low back pain (15%), imaging tests like MRI excel at identifying structural abnormalities in nerves or bones, such as herniated discs or spinal stenosis.
However, a significant portion of cases are non-specific low back pain (85%), where no clear abnormalities are found on MRI images.
The ILC diagnosis involves carefully listening to symptoms like back pain, numbness, and difficulty walking, delving deeply into each patient’s lifestyle background.
By combining this information with the latest insights, we uncover causes of back pain invisible to imaging alone.

The Multiple Elements Contributing to Low Back Pain

While low back pain is often categorized as specific or non-specific, in real patients these elements almost always overlap.

While MRI is excellent for identifying structural issues (the specific back pain), we also dig deep into the remaining 85% by listening to your life history and analyzing factors like muscle tension, blood flow, and nerve sensitivity (the non-specific back pain), which don’t show up on scans and overlap, thus amplifying the pain.
ILC diagnosis is able to evaluate and isolate each of these overlaps individually.

Specific Low Back Pain

• MRI System
• A device that captures cross-sectional images of the body without radiation exposure, unlike X-ray or CT scans.
• X-ray Imaging System
• Used primarily to evaluate bone alignment and structural changes from the neck to the lumbar spine.
• Fluoroscopy System
• Allows real-time visualization of the patient’s body during procedures, enabling precise and safe treatment.

Structural abnormalities such as disc herniation, bone deformity, or inflammation can be identified through MRI, X-ray, and physical examination.

MRI is extremely useful for identifying the causes of low back pain, but different sequences highlight different information—much like changing camera filters.
We will explain the three main MRI imaging methods: “T1-weighted MRI,” “T2-weighted MRI,” and “STIR MRI.”
Each of these images has different strengths. Physicians will analyze these images comprehensively to identify the cause of pain.

T1-Weighted MRI: Used for Viewing The Structure

Fat appears white, and the boundaries of muscles and organs are clearly defined, making it ideal for confirming the shape of the brain, internal organs, and bone structure. Think of it like a map; just as you can see the shape of buildings and the layout of roads, it helps identify spatial relationships and structural issues within the body, and shows the clear boundaries of muscles and organs, helping us identify physical deformities or tumors.

T2-Weighted MRI: Used for Viewing Abnormalities

This technique excels at highlighting “fluid” and “inflammation” caused by disease or abnormalities. Many conditions like hernias, tumors, or strokes involve inflammation, increasing fluid content. Areas appearing bright white on T2 images likely indicate an unusual condition of some sort. Think of it like an X-ray highlighting abnormalities. While X-rays show fractures as white, T2 images show inflammation as white. Therefore, it provides clues for identifying the cause of pain, as in: “The area around this lumbar nerve is glowing white, indicating inflammation.”

STIR MRI: Used for Detecting Hidden Inflammation

By intentionally suppressing fat signals to make them appear completely black, it highlights hidden inflammation or edemas as white spots. Think of it like stars glowing in the darkness. By eliminating the surrounding bright light (fat), faintly visible small lights (inflammation) become clearly discernible. This is highly effective for identifying pain causes difficult to detect with standard MRI, such as osteomyelitis, bone contusions, stress fractures, and “edemas.

But can resolving structural abnormalities (specific factors) alone completely eliminate pain?
Besides the abnormalities visible on the image, there are always hidden functional abnormalities (non-specific factors) that do not appear on the scan.

In this MRI image, a negative chain reaction is occurring: the bone displacement (spondylolisthesis) is causing a narrowing of the nerve pathway (spinal stenosis).
It’s not just about looking at the misalignment itself, but how it affects the nerves and surrounding inflammation. Unraveling this complex interplay is the essence of the ILC diagnosis.

Even if you receive a diagnosis like spondylolisthesis or stenosis (a specific low back pain diagnosis), it doesn’t necessarily mean the cause lies solely there.
Years of structural distortion almost invariably lead to factors not visible on imaging (non-specific factors) such as adjacent muscle stiffness, poor blood flow, and even nerve hypersensitivity.

The ILC diagnosis simultaneously assesses not only the imaging-visible diagnosis (specific factors) but also the accompanying body stress signals (non-specific factors). This is precisely why it is able to pinpoint the true nature of pain that hasn’t been resolved elsewhere.

Spondylolisthesis + Spinal Canal Stenosis (Example of Combined Conditions)

Non-Specific Low Back Pain

Approximately 85% of low back pain is classified as non-specific—functional pain with no clear abnormality visible on MRI or X-ray.

Pain from functional abnormalities where no clear abnormality is found on MRI or X-ray is called “Non-specific Low Back Pain.” Identifying such pain requires a multiple diagnostic approach to determine if the pain signals originate from the Body or the Brain.

Signal Originating from the Body

These refer to issues rooted in physical tissues or structures, which are difficult to detect with traditional imaging:

• Micro-inflammation/Damage to the Nerves: this occurs when nerves are slightly compressed or inflamed due to accidents or repetitive motions.
  While MRI can show the nerve’s structure, it may not fully capture its function or subtle inflammation.
• Muscle Dysfunction: this is a state where muscles do not function correctly, becoming excessively tense during specific movements or conversely losing strength.
  This can place stress on joints and cause pain.
  
• Fascial Adhesion: when the fascia covering the muscles stiffens and loses its ability to slide smoothly, placing limits on movement and leading to pain and stiffness.

These issues are often missed by standard MRI or X-ray imaging. ILC diagnosis combines ultrasound imaging and nerve conduction studies to identify such subtle problems and pinpoint the root cause of pain.

Signal Originating from the Brain

For pain previously deemed unexplained by conventional tests, we investigate why chronic stress, anxiety, and past traumatic experiences can heighten pain perception.

• Contrast with Physical Test Results
  When “signals from the brain” arise, chronic stress, anxiety, or past traumatic experiences can cause the brain’s pain-processing areas to become hypersensitive.
  As a result, even after physical issues are resolved, the brain may continue to send “pain signals” on its own. This can cause even minor stimuli to feel intensely painful, or pain to be felt in situations that should not normally cause discomfort.
  ILC diagnosis identifies these “Signals from the Brain” by first confirming, through tests like MRI, that there are no obvious physical causes. Detailed interviews and psychological assessments are then conducted. This allows for a comprehensive determination of whether the pain originates from physical causes or from excessive brain activity.

• In-depth interview and psychological evaluation
• A detailed medical interview is performed, covering when the pain began, when it intensifies, and any potential links to emotional stress or past trauma.
  The timing of increased pain may be associated not only with physical movements but also with mental stress, anxiety, or specific situations.
  It is scientifically proven that anxiety, depression, and fear (including fear avoidance behaviors) can worsen pain.
  Using questionnaires that assess these psychological states, we clarify the extent to which psychological factors may contribute to the pain.

• Neurological Function Assessment
  We check whether peripheral nerves are functioning correctly and evaluate the presence and extent of nerve damage.
  If pain persists despite the absence of issues during this examination, the cause may lie in the function of the central nervous system (i.e. the brain).
  We comprehensively analyze the root cause of pain by utilizing findings from cutting-edge research, such as fMRI, in addition to conventional imaging diagnostics like MRI.

Looking Beyond the Diagnosis— The ILC Approach: A Message to All The Patients Who Have Received a pathology diagnosis Before

Knowledge Is Key

What appears on your MRI images can be compared to a tree’s “growth rings”, but in your body — evidence of the long years you have worked hard for your family and your job.
So, instead of denying the results of your imaging tests, first let’s start by accepting them.
Hearing unfamiliar, complex names like “Spinal stenosis,” “spondylolisthesis” thrown around by the doctor can sometimes feel unsettling, but these are merely natural changes occuring in your body, much like wrinkles forming on a face.
The misalignments and narrowing in your bones are your lower back’s ‘medal of honor’ for supporting your family and walking all these years.

The pathology is simply proof of how hard you’ve worked until now.
So first things first, please give your body, which has worked so hard on your behalf, some long-deserved thanks and appreciation.
Finally putting a name on this medical condition of yours doesn’t mean that your body has suddenly broken down or is not good anymore.
What matters more than “what the MRI shows” is “how to live comfortably with this body and make the best of it.”

Thinking Is Paramount

The Venerable House Metaphor

Think of your body as a venerable house that is beginning to show its age.

A house’s structural age does not necessarily determine how comfortable it is to live in. The “wear and tear of your home” and its livability are two separate matters.
Let me explain why pain can change even with abnormalities on an MRI using the analogy of the “old house.”

The Exterior and The Roof: what is visible on the images (Diagnosis of the pathology) (Specific)

Loose roof tiles (Spondylolisthesis) or misaligned pillars (canal stenosis). In a 50 or 60-year-old house, these are a natural occurrence and do not necessarily make the house unfit for living.

Some tiles have shifted out of place (i.e. spondylosisthesis), misaligned pillars (canal stenosis)
These are perfectly normal in a 50- or 60-year-old house. They alone don’t make the house uninhabitable, right?

The Interior of The House (the true cause of pain / Non-specific):

Poor ventilation (blood flow): the blood has a tendency to stagnate around the nerves.
Room chillness (stiff muscles): Muscles get stiff and cold.

The anxiety of the resident (the mind): Fear of collapse one of those days contributes to heightening the sensitivity to pain.

Although straightening the pillars (i.e. the pathology) would involve a full scale renovation, the simple act of “improving the ventilation and warming up the rooms” (adjusting blood flow and muscle flexibility) can make a whole world of difference in terms of general comfort. The same applies to the lower back: even without changing the general structure of the bone (specific), adjusting blood flow and muscle flexibility (non-specific) can go a long way to make the pain surprisingly easier to manage.

Performing Key Adjustments

The Rusty Pipe Metaphor

Why does pain vary from day to day? Why does walking cause pain? Let’s explain using the analogy of the rusty pipes and the way water flows.

Spinal stenosis is like a slightly rusty water pipe whose flow has narrowed as a result. However, if the water inside (blood flow) flows smoothly, there is no reason for it to clog.
However, when the body gets cold or remains still for too long, the water becomes thick and sludgy, making clogging (i.e. pain) more likely to occur.
Even if altering the pipe’s thickness (stenosis) is not possible, you can start today by improving the water flow (blood flow) by yourself.

Staying warm
Soak at length in a warm bath. This alone will resolve the hidden cause not visible on the imaging: the insufficient blood flow (Non-specific factor).

keep swaying
Not strengthening, but loosening the muscles. Simply sway your hips like a swimming goldfish during walks or light exercises to remove the “rust” from your muscles. (exercise therapy)

Taking sunlight in
Staying indoors due to the pain is actually the worst choice possible in that instance. Just walking a bit around your neighborhood to soak up sunlight shifts your mood away from the small stress weighing on your mind, thus quietening the brain’s pain sensors (psychological stress).

Treating Your Self “As a Whole”, not Just That Single Spot of Pain

Why has your back pain failed to heal so far?

It might be because you’ve only been chasing the “single abnormality” visible on your MRI scan.
Lower back pain arises from a complex interplay of bone deformation, nerve inflammation, muscle tension, and mental anxiety.
Treating just one of these causes, while leaving the others untreated, won’t fully improve your symptoms.

The ILC Diagnosis used at our clinic meticulously unravels the complex “chain of pain” — not just diagnosing conditions visible on MRI scans like “bone deformity” or “nerve inflammation” (specific low back pain), but also addressing the accompanying “muscle tension” and “mental anxiety” (non-specific low back pain) that are the body’s cries for help.

We help the patient reclaim a pleasant life free of pain by looking at that person as a whole, not just the images.
So, let’s find the exit strategy to your back pain together.

Written by: The administative Director of ILC Clinic