The truth about surgery, MRIs and X-rays for back and joint pain

By Dr. Adam Cramer, PT, DPT; MyoFit Clinic

I meet many people in our community who come to me with X-ray or MRI results from an orthopedic surgeon and a laundry list of diagnoses that often have little to do with their symptoms. To help you become better informed and avoid being manipulated by results and being driven by fear into inappropriate testing and poor outcomes, I want to shed some light on how significant these results actually are.

Let’s clarify some things to help you save time, money, stress and to get you effective treatment more quickly.

MRIs and other imaging advancements are very valuable in diagnosing, treating, monitoring, and managing numerous diseases. They have improved medical knowledge and interventions. They are absolutely necessary in many instances. However, it may surprise you to learn that because they produce so many false alarms, medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain. Ever wonder why surgeons and physicians may say, “we won’t know fully until we get in there,” despite the fact we have this awesome imaging? Well, interpreting imaging can be complicated. Even though we have this amazing technology, it is still difficult to determine with 100% certainty what an image shows.

When read appropriately, there are very clear, positive findings that even a layman could identify. Does that mean we’ve identified the cause of the pain? Unfortunately, no. “Positive” findings on an MRI are extremely common, to the point where they aren’t significant in diagnosing the cause of back and joint pain. If you took a random group of people who felt great, with no back pain whatsoever, and made them get an MRI just for kicks, over half of these pain-free people would have “positive” findings. Just having a disc bulge, disc protrusion, degenerative disc, cartilage degeneration, joint space narrowing or other “positive” findings on an MRI does not mean the cause of your symptoms and pain has been identified. This is even more true with each passing decade of life. The likelihood there will be a “positive” result on your MRI increases as you age, regardless of symptoms.

Knowing this, the worst thing I’ve seen people do is get an MRI because of their back and joint pain and receive the impression from the doctor that they have bone on bone joint, facet degeneration, degenerative disc disease, bone spurring, or other malady and assume they are broken and will have back and knee/hip problems forever. Absolutely not.

The findings on imaging do not always correlate with symptoms, and it doesn’t do you any good to make back and joint pain pathology a part of your identity. Embracing the idea that there is something mechanically wrong with your back and joints can lead to fear of movement, a hypersensitive nervous system, balance deficits and chronic pain. This will lead you to not moving at all due to fear of making things worse, when the reality is if you don’t move it dramatically makes your symptoms worse.

Any physician who says physical therapy will only make your problem worse has no idea what they are talking about and is not aware of the abundance of medical evidence supporting a physical therapy first approach for back pain and joint pain. Getting injections, nerve blocks, immobilization boots and avoiding your mobility is what will make things worse. These providers, which included orthopedic surgeons, primary care physicians, podiatrist and pain management doctors, have never made anyone walk again, use their shoulder again or return them to sport/work before. They are not trained to do so. If you are having difficulty walking because of pain, then why consult with a medical provider who is not trained to help you walk again? Physical therapists will not “fear” you into making uninformed decisions regarding your health but will instead inform you properly on your diagnosis so you can make the best educated decision for what’s best for you.

A physical therapist will diagnose you properly based on your functional limitation and work with you directly on improving that limitation, returning you to normal mobility.

The physical therapy profession is designed to teach and inform you on what is really happening with your body. You will spend, on average, two to three hours per week for four to six weeks with a physical therapist learning about your body and getting treatment at the same time.

The human body has not changed for thousands of years. Your muscles, spine and joints did not get where they are overnight and will not improve overnight. It takes consistency, dedication and a willingness to be informed properly. In doing so, you will have success. Your body and health are worth it, and you owe it to yourself.

I encourage you to seek care from an independent Doctor of Physical Therapy at MyoFit Clinic, where there is no conflict of interest. He or she can work with you to treat you as an individual, addressing your injury and symptoms, and not solely treat your imaging findings.

If you don’t want surgery, don’t see a provider that offers surgery. See a physical therapist who accepts in-network insurance benefits, which will enable you to receive the highest quality care to help you avoid surgery and help return you to a pain-free life. This is what MyoFit Clinic offers.

Adam M. Cramer, PT, DPT, is a licensed physical therapist, pain specialist and founder and CEO of MyoFit Clinics in Chardon, Ashtabula and Middlefield. Call 440-286-1007 for a consultation to avoid orthopedic surgery. Visit MyoFitClinic.com to learn more.