Do I Need an MRI?
I get asked this question at least a couple of times per week. Our culture places such a high value and authority on imaging. In America, providers are using MRIs as a primary diagnostic tool to evaluate a patient. Is this truly the best tool to assess a patient? Yet time and time again we see it play out, we watch elite athletes get an injury and the reporters stating the athlete is undergoing MRI and X-Rays to rule out different injuries. Our society has raised MRI to be the gold standard of care for assessment of a patient. In 2019 there were nearly 40 million MRI’s conducted in America, the costs being substantial to the consumer. Is imagining really the best way to understand a patient's pain and depth of injury? What happened to hands on assessments?
Several years ago, before I was a therapist, I received an MRI for a strained chest muscle. During the MRI doctors found a torn labrum (cartilage) in my shoulder, an unrelated problem to my initial concern and reason for receiving an MRI. I was completely surprised and caught off guard because I had no pain from this torn labrum. I asked the surgeon why I wasn't experiencing pain at the said site of tear but I never got a real answer.
Here's the problem with MRIs…they don’t actually diagnose where the pain is coming from! In a study in 2011 the authors concluded, MRI’s can depict anatomical structures such as discs, nerves, muscles, tendons, ligaments, and bones within the spine, but MRI’s do not necessarily depict the source of back pain itself. If an MRI cannot tell us WHY the pain is there, why do we as providers use it as a starting point for determining treatment options? I often tell my patients getting an preliminary MRI is like shining a flashlight on all the things wrong with you. It doesn't give us clear answers into why the pain started in the first place.
There was a study that took and examined MRI’s of people WITHOUT low back pain. They discovered people without low back pain actually had abnormalities in their spine too. The MRIs found problems from slipped and herniated discs to degeneration and arthritis. Yet none of these people were experiencing back pain. Take a second to marinate on this. This means MRIs can not make a correlation between a result and pain. Well isn’t that why we were getting an MRI’s in the first place?!
When we realize that MRI’s and pain do not always show cause and effect we can better understand the role of an MRI. MRIs are supposed to be a tool to create a larger picture and add to the provider’s assessment. Let's take a moment to highlight some studies that looked at how the brain interprets information regarding aspects of MRI’s. I recently read an article that people who undergo MRI’s are twice as likely to get surgery compared to people who did not receive imaging. If we aren't bothered by it, but some test our doctor recommends tells us that there is something wrong…we tend to believe it. Our brain is a powerful thing and can convince us of almost anything, including our pain.
When our clients ask about MRI’s we make sure no red flags are present on assessment. Assuming no red flags we tend to advise clients to save their money and proceed with conservative therapy first. Based on sound literature, waiting to get an MRI saves the patient both time and money, and reduces the possibility of surgery (Modic 2005).
When you are dealing with an injury or pain, consider seeing a licensed Doctor of Physical Therapy first. You do not need a referral to get an initial evaluation and start treatment. We’ll give you our best advice on navigating this complex healthcare landscape.
Dr. Ryan Perez, PT, DPT, OCS, CSCS, Cert. DN, owner
Endean A, Palmer KT, Coggon D. Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine. 2011;36: 160–169. doi: 10.1097/BRS.0b013e3181cd9adb
Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. NEJM. 1994:331;69-73.
Shubha SV, Deyo RA, Berger ZD. Application of “less is More” to Low Back Pain. Arch Intern Med 2012;172(13):1016-1020.
Modic MT, Obuchowski NS, Ross JS et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology 2005;237 (2):597-604.