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How Important Are MRIs?

August 4, 2016


Often times, individuals receive their MRI results and find it disconcerting. MRI results can show multiple levels of herniation, osteophyte formation, severe arthritis, decreased disk height, increased signal intensity, or any combination of these dysfunctions. After reading your results, what should you do next? Are surgery or injections the only options? The answer is a resounding no. The truth is, “abnormal” findings on an MRI are quite normal. Our bodies degenerate over time; it is a part of life. I am not saying this means throw caution to the wind and don’t take care of yourself, but I am saying don’t put all of your stock into an MRI report. An abundance of evidence (see links below for some light reading) demonstrates MRIs on the spine don’t enlighten us on the source of pain (with the exception of a space occupying lesion, i.e. a tumor) or the future success/failure of treatment.

Imaging reports, particularly MRI, are inconsistent with symptom presentation in symptomatic and asymptomatic patients. A majority of symptomatic patients have normal MRI reports while a significant portion of asymptomatic patients have “abnormal” reports. One study shows roughly 70% of asymptomatic patients in their 20s have at least one herniation in their neck. 70%! Yet they have no impairments requiring action. Of the 1,211 total participants studied, 87.6% had a least one level of herniation, yet only 5.3% had spinal cord compression. This tells you that simply having a herniation does not mean you are impaired or in any danger of damaging your spinal cord.

To take it a step further, receiving an MRI is often times more harmful than beneficial. Early MRI can lead to poorer outcomes for patients with low back pain. Early use of MRI can cause fear-avoidance behaviors, which can intensify symptoms and delay recovery. Utilizing advanced imaging adds anywhere from roughly $2,500 to $4,800 in additional costs to the total bill for treating back and/or neck pain. These costs come through unnecessary additional tests, medication prescription, injections, delayed physical therapy, lost time at work, etc.

Many studies speak directly against using medical imaging for all the reasons mentioned above. MRI results are commonly shown to be different than the diagnosis given. The only findings found to be commonly associated with low back pain is spinal stenosis. Stenosis can be evaluated and screened in a clinical setting allowing for a proper MRI referral. Most of the diagnoses given on an MRI report simply don’t play a role in a patient’s functional level of pain. Furthermore, they won’t hinder the patient from getting better.

So how does this pertain to you? If you have back or neck pain, please seek a physical therapist first. Receiving early physical therapy within a plan of care will help reduce many of these unnecessary costs, the foremost ones being imaging and surgery that would be prevented through proper care. A physical therapist will be able to properly screen your symptoms and determine if further assessment by a medical doctor is needed. In most cases however, back and neck pain can be successfully treated with physical therapy (regardless of what your spine looks like on an MRI).

About the Author

Dr. Zach Walston, PT, DPT, OCS is National Research Director at PT Solutions Physical Therapy. Dr. Walston earned his BS in Human Nutrition, Foods, and Exercise at Virginia Polytechnic Institute and State University. He then received his Doctorate of Physical Therapy from Emory University. While at Emory, Dr. Walston received the Johnnie Morgan Award for Excellence in Clinical Science. He is a graduate of PT Solution’s Orthopaedic Residency Program and utilizes his expertise in rehabilitation, exercise, and nutrition to help patients recover from current injuries and prevent future ones.




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