Pain Truth or Myth: Do You Need to Get an MRI Before Seeing a Physical Therapist?
As the school year begins, summer vacations are coming to an end. Chances are, you or someone you know may have had a flare up of back pain while traveling, trekking beach gear down the boardwalk, or engaging in weekend warrior shenanigans.
Believe it or not, each year 15% of the population has their first episode of back pain, and over the course of our lives a whopping 80% of us will have back pain at some point. We see these episodes all the time in our practice and the first question we often receive during an initial visit is, “Should I have gotten an MRI before coming to see you?”
The truth is that even though back pain is common, the medical community does a poor job managing it. We hear scary stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability. So, it’s no wonder that when you have an episode of back pain, an MRI is often recommended to determine the cause of the symptoms.
This may sound surprising to many people, but MRIs are rarely needed or helpful to treat low back pain or any other pain-related issue. Being aware of this will actually save you time and money when trying to find a solution to your problem. The main reason for this is because research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common.
Here are some alarming stats regarding low back pain:
90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge.
Simply getting an image increases the chances that you’ll have surgery by 34%. Maybe you don’t have low back pain, but are struggling with pain in another part of your body.
These stats are also telling in HEALTHY, PAIN-FREE PEOPLE:
33% of ALL people had a rotator cuff tear 80% of people had a disc bulge in their neck 75% of baseball pitchers had rotator cuff damage 65% had cartilage damage in their knee 25% had a meniscal tear in their knee
These numbers show that there are a lot of “problems” that aren’t causing ANY pain!
The answer often lies in the expertise and thorough assessment by your provider. This means that finding a doctor or physical therapist that spends time with you in deep discussion about your problem(s) is what it takes to figure out the answer to that question.
We like to say, “the mystery (of the problem) is in the history (leading up to the problem).”
Another important point to note is that most pain is movement specific, meaning it’s a movement or posture that provokes the symptoms. Because physical therapists are movement experts with a keen eye for abnormal movement patterns, they recognize problem areas that may be the culprit of the pain. In contrast, an MRI is most often done lying down in a stationary position. There is no movement involved with an MRI, so who knows how your spine really performs under normal daily stresses and if any abnormal findings are the actual cause.
From the perspective of a physical therapist that thoroughly evaluates a person experiencing pain and assesses their movement, the treatment plan for clients is not based off of the MRI findings. Each person is evaluated individually and the treatment addresses the impairments found. In other words: we don’t treat scans, we treat people.
So, the next time you are at the doctor’s office discussing your pain and the doctor suggests that you need an MRI, ask if the MRI results will change your treatment plan? Because all too often, the answer is no. Instead, seek the help of a good physical therapist that does not develop a treatment plan based off your MRI findings. A treatment plan based on a combination of factors from your evaluation is key. This encompasses the understanding of the history of your problem, your complaints, your functional limitations, your movements that provoke your symptoms, and your goals.
Remember, a skilled physical therapist should be able to determine what is causing your problem without diagnostic scans, however the more important factor is why your body hurts and how it can be fixed.
Despite the data showing that physical therapy is the most effective, safest, and lowest cost option to treat low back and other pains, most people take far too long to get there. What many people don’t realize is that Georgia has Direct Access. This means you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for pain somewhere in your body and PT isn’t one of the first treatment options, ask for it!
The PTs at Functionize Health & Physical Therapy are ready to help you find solutions to your problems. Don’t wait until it’s too late, contact us today: 404.907.4196 or firstname.lastname@example.org