Do I need to get a MRI first??
This is a very frequent question that I get from clients, especially those with neck and back pain.
Many clients think they need an MRI or Xray before starting physical therapy because “I don’t want hurt myself more”. Or, like my own mother said… “I don’t want to go to the doctor because they will make me get a MRI and I’m not going into that tube!” It’s normal to be anxious about your care, especially when you’re having pain shooting down your leg, or numbness in your arm. But don’t let those fears keep you from getting the care you need. The sooner you start addressing your symptoms the more likely you are to get relief without medication, surgery or injections.
I can certainly understand why it’s tempting to get an MRI, especially when looking for an answer and cause of your pain. MRIs are an amazing advancement in technology that can easily diagnose abnormalities in the spine or joints, tumors, cysts or other tissue damage. However, MRIs, and Xrays too, can give a lot of false alarms, especially when talking about back and neck pain.
What? False Alarms?
You see, MRIs are so good at what they do that they find many problems and disc degeneration that most of us already have starting as early as our late 30’s. Just because you have degeneration, doesn’t mean you have pain. Multiple studies have shown that MRI results of stenosis, disc herniation, and nerve compression are positive, even on test subjects with NO PAIN! In addition, the radiologists reading the MRIs have no clinical context of what pain the patient is having, and they will address any degenerative changes they see creating a list of diagnoses that may have NOTHING to due with the cause of pain. Even if the MRI is detecting a problem that is the site of the pain, the MRI can not predict your own body’s ability to heal. I’ve had a few myself, but in the end, they have made no difference in my recovery.
So how do I find out the ROOT CAUSE of the pain?
Most people don’t realize that 70-80% of all spine and musculoskeletal problems are “mechanical”, which means the problem is related to the way you move. You could have muscle imbalances, tight muscles and joints related to bad posture, previous injuries, or general “wear and tear” on our joints. Many of these problems start to show up in our 40’s, 50’s, and 60’s due to years of bad movement patterns and compensation. The easiest way to find out about these “mechanical issues” is to ask a physical therapist. These movement and strength imbalances are best corrected with … Movement and Strengthening!
Why not be over cautious and get an MRI anyway?
If you have had a traumatic accident, a fall, or a long history of pain, then YES, seek medical advice and probably a MRI. But it you have a history of a nagging pain, that has recently gotten worse, or started to affect your ability to do the activities you enjoy, then seeing a physical therapist is a good idea. A physical therapist is a movement specialist and can determine if it is not a mechanical problem and if you need to be referred to a physician. A physical therapist may be able to save you money for the cost of the MRI and the anxiety of “going into the tube”.
Here's another article that gives even more information about the overprescription of MRIs and how they can lead to chronic pain, use of medications, and higher disability scores.
You can always download our Free E-Book 9 Ways to Relieve Back Pain without Taking Pain Medications or Missing the Activities You Love for tips to try and manage back pain at home.
Physical Therapy: Common
Physical therapy has always been shrouded in mystery, and the truth is many people don’t really know what it is. Some think that physical therapists only stretch muscles, rehabilitate athletes, or use that electric stimulation machine. Others feel as though physiotherapy is an intense massage, or even just a way to avoid being stiff after a workout. As a physical therapist with many years of experience, I can honestly say that, despite all these conflicting ideas about physical therapy, one thing remains constant: most people believe we heal pain. And yes – we do heal pain, but
what most people don’t understand is that physical therapy is NOT only about healing pain… it
is about SO much more than that.
Most patients come to see me wanting nothing more than for the pain to be gone. And that’s something we can all understand – pain is absolutely terrible. But the most common misconception about physical therapy is that ALL physical therapists do is take away the patient’s pain. That just isn’t true.
Let me explain. If all a patient really wanted was for his lower back pain to be gone, or for her knee pain to disappear, then he/she would simply take a painkiller. And in my experience, many of the patients visiting my clinic have ALREADY done that. And the pain is STILL there when they first come to see us. So, getting rid of the pain isn’t the only issue the patient is facing. If pain relief is the only thing that’s required, the painkillers or the injection would
have worked… but they haven’t.
The unfortunate truth is that many people see pain as the problem, not the symptom. And it is this precise disconnect that defines what a physical therapist does: physical therapy finds the CAUSE, applies a whole body approach to heal the problem, thereby getting rid of the pain. The intensive physical therapy a person undergoes after a knee or hip surgery is NOT only so that he/she will not be in pain, but so that the root cause of the problem is healed, thereby promoting maintained health. Similar is true for someone suffering from lower back pain: physical therapy
doesn’t start by healing the pain, but rather tackles the root cause in order to eradicate pain permanently. So, in other words, though physical therapists love to get rid of pain, we do so in a way that treats pain as a symptom, not the problem.
Our goal is to provide lasting health, not temporary comfort. That’s why seeing a physical therapy involves a hands-on, thorough evaluation, and recommendations usually for multiple sessions. I see the same thing happening in my practice all too often, that is, after a session or two with a physical therapist the patients feels great – his/her pain has dissipated, and life is back to normal. The problem is, he/she then stops coming to physical before completing the recommended number of sessions, healing the root cause of the pain, and the pain returns.
It is this common scenario, too, which casts physical therapy under a cloud of misunderstanding. As we do not deal with the management of pain so much as the HEALING of the problem, patients often assume that if their pain is gone there is no need for further treatment. Or when pain returns, it is assumed the physical therapy didn’t work. The truth is, physical therapy isn’t a painkiller – and thank goodness for that. Though a session or two might ease the pain, it’s imperative to continue seeing a physical therapist for the suggested duration of your treatment in order to attain PERMANENT health and a pain free life. Unlike pain medicine, physical therapy is the most effective way of healing the CAUSE, and the happy truth is that, along the way, the pain will dissipate.
So, based on the above, here are some things that a physical therapist actually does:
Physical therapy is, of course, useful for eradicating pain. But the truth is, a common
misconception lies is precisely HOW we do that. We do not offer temporary solutions to a
permanent problem, rather we tackle the root cause of the problem so as to heal the
So, there you have it: the most common misconception about physical therapy, namely, that
physical therapist only treat pain. We do so much more than that, and with the proper, hands on,
unique treatment that physical therapy provides, a patient who does the required
sessions, and commits to the therapy prescription, will ultimately maintain a pain free,
active life. Stop the painkillers, stop the injections, and stop the visits to the physician:
physical therapy is by far the most effective way to achieve and MAINTAIN a pain free, active life.
As the holidays approach, my family and I did some cooking baking this weekend. It's become a tradition that we all look forward to, both the baking and the eating of the cookies. When taking break from washing pans and cleaning up frosting from the floor, I came across this cartoon which made me laugh. Not just because I was tired from baking and sore from standing so long. No, this is funny to me because it is what my husband says I went to PT school to learn. "Just put some ice on it."
That might be what he frequently hears from me when says his knees hurt after running. Possibly because he tells me in between making dinner and doing laundry, and I don't have time for the long answer. But the truth is, cold packs or ice can be very helpful for pain and inflammation relief after an initial injury or a challenging work out. High level athletes have learned the benefits of cold therapy after a game or practice, which is why they leave the training rooms with packs of ice wrapped around their knees or shoulders. Ice tubs/ice baths are also popular in training rooms, and you may see them in some gyms now too. But ice can also help us regular people who are sore after starting to exercise again, or standing too long at the festival, or even after lifting a box that was too heavy.
Cold packs will contract blood vessels, significantly reduce inflammation of joints, tendons or muscles, and thus reducing pain. The cold temperature can also slow the nerve activity rate, decrease muscle spasm, and decrease the perceived pain. Cold therapy (formally called cryotherapy) is most effective in the first 48 hours after the strain or injury. By controlling the inflammation initially, you can return to activity sooner and avoid falling into a chronic inflammatory state
Cold or ice can be use in different forms: gel packs, ice packs, ice baths, or ice message. A bag of frozen peas also works just as well. It is most effect used for short periods of time, 10 - 15 minutes, multiple times during the day. It is important not to place ice directly on the skin or leave for longer than 20 minutes to avoid any risks of skin damage.
While some people love to use ice to control pain, it is NOT for everyone. Clients with arthritis often feel very stiff after using ice packs. Diabetics with any type of neuropathy will not tolerate the cold temperatures and will find it very uncomfortable. Ice packs are also not the best option for those with poor circulation.
If you find ice helpful in managing pain and swelling, then great! But if your symptoms continue past 48 hours you need to see a professional for care to avoid any further injury or chronic pain. I promise, I have learned more from PT school and 20 years of practice than "Just put some ice on it!"
Every week I hear many patients ask us the same question: “how can I keep active even
while I’m recovering from an injury?”. I get it.... you’re fed up of resting
the problem area in the hope that things will get better. Is this you? Keep reading!
We often find that the general advice given by doctors (and sometime even the internet!) is
that ‘rest’ is the best thing for an injury. In the hope of healing faster, the patient then rests
the problem area for prolonged periods of time. Later, though, once he/she attempts to get
back to his/her activities, the pain is still there and often it’s even worse than it was at the
There are two major flaws in the ‘rest your problem’ strategy. The first issue is that an active
person finds the idea of prolonged rest to be almost impossible, if not unbearable. Secondly,
resting the area for long periods of time can actually be even more harmful – but, more on
Let’s take a look at a fairly common scenario I encounter with my clients on a regular basis.
Quite a few of the patients I treat are generally active adults, and though they may not be
professional athletes, they do enjoy running or cycling over the weekends. I often find that
once an active patient sustains an injury – like a leg or groin injury in a runner – he/she finds
it difficult to swallow the doctor’s “rest” pill. In fact, all those kind of patients want to know
is when they can start running again!
And I absolutely love hearing that question! In fact, I dislike the “rest” prescription as
much as the actual patient! Here are the two major problems I always try to make our
patients aware of:
Firstly, rest almost NEVER actually fixes anything. Think about that for a moment. Our runner
has injured his leg and is advised to rest it. What happens when he does? Well, the root cause
of the problem isn’t addressed – in fact, it is often hidden behind painkillers. The problem
with this is that the real healing just cannot begin. It’s as though the patient is, really, just
wasting valuable time.
Secondly, resting the problem area for prolonged periods of time results in what is called
“whole body de-conditioning”. That is to say, just because the patient experiences pain in the
leg does not mean his/her entire body is incapable of staying active. Here’s the problem with
a full-body rest-up: the entire body loses strength, power, endurance, and flexibility. Once
this happens, the recovery time needed practically doubles! Remember, healing the problem
area – and SUCCESSFULLY addressing and fixing the root cause of the problem – is really only
possible when the muscles surrounding the issue are strengthened. This strengthening helps
with support and flexibility, ensuring that the muscles in the affected area no longer
overcompensate and create pain. Not strengthening these critical surrounding muscles only
aggravates the issue at hand. The key is to adapt the patient, that is, to ensure that he/she
keeps active in a safe/sustainable way – always building back up to the run, the walk, or the
cycle. Doing this keeps the patient motivated, strong, and gives him/her the best possible
start on their journey to health.
So, if you’re resting because you’re injured, but you only find more pain at the end of the
day, then it’s time to make a change. Here at Blue Wave Physical Therapy and Wellness, we can help you.
Our team will help you get back to the activities you love in no time at all. With custom-made exercises
suited to your routine and recovery, we aim to heal the root cause of the problem. If you heal the root cause of the
problem then you are sure to create a strong foundation for the MAINTENANCE of a pain free
life. This means that running, walking, or any activity you love will no longer cause anxiety
or worry. We want you to get back to doing what you enjoy!
If you’re ready to finally sort that pain out, to get off of the sofa and back out running or
doing what you love, give us a call TODAY. We look forward to helping you get back to health
safely, quickly, and effectively.
I know that when I’m hurting, the last thing I want to do is get moving. But I also know that’s what I need to do. That’s one motivation for me to get to the pool in the mornings. Our bodies are made for movement. When we don’t move, we get weaker and lose flexibility, our circulation slows down as well as our digestion. Frequently, our lack of movement and inability to do the things we want to do can lead to symptoms of depression and anxiety.
Apparently, a lot of Americans are hurting due to injury or disease. I’m sure you have heard that Americans are in the middle of an “Opioid Epidemic” from pain medications such as Vicodin, Lortab and Oxycontin. According to the Center for Disease Control (CDC), 11% of American experience pain on a daily basis. In 2012, 259 million prescriptions for opioids were dispensed, and 1 and 4 of the people receiving those prescriptions already struggle with addiction. Another study of Medicaid patients showed that 61% of opioid related deaths were related to chronic pain diagnoses. That’s why the CDC released a new set of guidelines in March 2017 with safer alternatives for long term- pain management. Physical therapists can play a key role in those alternatives.
A physical therapist is trained to guide a person through movement to improve the pain instead of masking it with medications. The “side effects” of physical therapy include improved mobility, increased independence, decreased pain, and prevention of other health problems through movement and exercise. As part of their new guidelines, the CDC cited “high quality evidence” supporting exercise as part of physical therapy treatment for familiar conditions like low back pain, hip and knee osteoarthritis, and fibromyalgia.
Before starting an opioid pain medication, talk to your physician or consult your physical therapist for information about alternatives and realistic pain management goals. Blue Wave Physical Therapy and Wellness helps those with chronic pain by using manual therapy techniques, specific stretching, education of safe movement and body mechanics, and gentle progression of movement.
We help active adults get back to exercising, feeling fit, and participating in the activities they love without medications, injections, or surgery.
Catherine Courtney, PT
Specialist Physical Therapist