Why you don’t need an MRI for your injury
By Dr. Adam Cramer, PT, DPT; MyoFit Clinic
Many patients come to MyoFit Clinic with X-ray or MRI results in hand from an orthopedic surgeon, accompanied by a laundry list of diagnoses that often have little to do with their symptoms. It is important for you to know how significant imaging results actually are in helping you become better informed, and to avoid being manipulated and driven by fear into inappropriate testing and poor outcomes.
MRIs and other imaging advancements are invaluable in diagnosing, treating, monitoring and managing numerous diseases. They have improved medical knowledge and intervention, and they are necessary in many instances. However, it may surprise you to learn that medical guidelines strongly discourage the use of MRI and X-ray imaging in diagnosing low back pain because they produce so many false alarms. If you ever wonder why surgeons may say “we won’t know fully until we get in there,” even though this imaging capability is available, keep in mind that interpreting imaging can be complicated. Even though we have this state-of-the-art technology, it is still difficult to determine with one-hundred percent certainty what an image shows.
When an image is read appropriately and there are very clear positive findings, it does not necessarily mean that the cause of the pain has been identified. Positive findings on an MRI are extremely common, to the point where they are not significant in diagnosing the root cause of the back pain. For example, if you took a sample group of people who felt great with no back pain whatsoever and had them get an MRI, well over half of these pain-free people would have positive findings on their MRI. Simply having a disc bulge, disc protrusion, degenerative disc or other positive finding on an MRI does not mean this is the cause of your symptoms and pain. This is even more evident with each passing decade of life. The likelihood there will be a “positive” result on your MRI increases as you age, regardless of your symptoms.
It is discouraging to see people who have received MRI imaging because of their back pain get the impression from their doctor that they have facet degeneration, degenerative disc disease, or any number of ailments and assume they are stuck with back problems forever. That is not the case. The findings on imaging do not always correlate with symptoms. Embracing the idea that “there is something mechanically wrong with my back” can lead to fear of movement, a hypersensitive nervous system and chronic pain.
The fact is that most low back pain can be diagnosed with a thorough medical history and physical examination, and treatment can begin quickly when performed by a physical therapist. Imaging is undoubtedly vital in certain situations, which an adept provider will easily recognize—such as if you are not responding to treatment after the expected amount of time. A doctor of physical therapy is trained to suspect a serious underlying condition, or if there are worsening or unrelenting neurological symptoms. Otherwise, the imaging is unnecessary and more likely to delay your recovery.
At MyoFit Clinic, a doctor of physical therapy will work alongside you to find the source of your pain, addressing your injury and symptoms, and not solely treat your imaging—because your imaging may not show you the bigger picture. If you want to avoid surgery and identify the root cause of your pain, seek a physical therapist who accepts in-network insurance benefits. This will enable you to receive the highest quality of care to help you avoid surgery and help return you to your normal, pain-free lifestyle.
Dr. Adam M. Cramer, PT, DPT, is a licensed physical therapist, shoulder specialist and founder of MyoFit Clinic located in Chardon, Middlefield and Ashtabula. Visit MyoFitClinic.com or call 440-286-1007 to find out more.