I’ve read a couple of blogs recently about x-ray and MRI imaging for spine pain (see below). I get questions in the clinic all of the time about this. Specifically, when an MRI is needed and if an MRI is needed to treat a back injury. The answers may not be what you expect. First don’t be fooled into thinking that more imaging is better care.
There are several limitations with imaging. The first thing is that imaging can’t find what the pain-generating structure is. Imaging may demonstrate all types of abnormalities or signs of degeneration. However, just because a structure looks abnormal on an MRI or x-ray does not mean that it is the source of your pain. One frequently cited study showed that over 50% of people without low back pain had evidence of a bulging disc. So just because you have a bulging disc, arthritic changes or another abnormality doesn’t mean that you have to be in pain. In fact I find that patients who have imaging performed can sometimes fixate on the results. These people will say they have a “bad back” because they have normal degenerative changes at L4-L5.
One study showed that people who received an MRI in the first month after developing low back pain were 8x more likely to have surgery and spend 5x more healthcare dollars. We live in an age where our healthcare system is overburdened and too expensive. I believe that we all have a responsibility to not overspend when it comes to healthcare. MRI is strongly correlated with increased money spent but patients don’t necessarily improve more.
One of the things that I see most commonly in the clinic is that imaging doesn’t quantify or speak to the way a person moves. Imaging is generally performed at rest so it inherently cannot show anything about how a person moves. Patients on the other hand usually have pain with particular movements. Often it is more important to change the way people move if we are going to change their pain. This is the one of the best endorsement for physical therapy that I can think of. Physical therapists are experts on human movement and the people most likely to change how you move.
Okay, so we have discussed some of the limitations of imaging. However, there are times when imaging is important and should be performed. For instance imaging can show cancer, infection or significant nerve problems. As a patient you should be aware of significant weakness in you legs, loss of bowel or bladder control, unexplained weight changes or fever. If you have these symptoms and/or your back hurts it is time to see a medical professional.
So remember more imaging doesn’t mean better care and if a image of your spine shows something it doesn’t mean you have a “bad back”. Treat your musculoskeletal problem conservatively first and give your body an opurtunity to heal itself. You may be surprised at how well you feel and how much simple activities will help.
Jon Hill, DPT Siskiyou Physical Therapy
