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.
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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