“My Back is Killing me, I think I need an MRI.”

I haven’t heard this exact phrase before, but I do have patients that feel that they need an MRI to know exactly what is going on, even after I’ve evaluated and treated them. An MRI, as a routine diagnostic tool for common low back pain, will not tell you why your back hurts, it will only show you things that are already there and which are common for most people.  Furthermore, an MRI for low back pain typically leads to more procedures and surgery than necessary, when a quick visit to a physical therapist can give you the tools you need to begin to heal and recover from back pain right away.  Physical Therapy for low back pain has better outcomes than surgery, is less expensive than an MRI and Surgery, and it is much, much, much less risk to your personal health and well-being.  People die in surgery, and Failed Low Back Pain Syndrome means that surgery did not work, which is about 50% of the time and this is a well documented condition (ie. problem)  in the medical literature.

Why do you need an MRI?  If you have neurological signs and symptoms including bowel and bladder dysfunction, your foot drops or drags, or possibly if you have a personal history of cancer.  Your physical therapist can determine if you need further evaluation by a physician.

I could not have said it better than Dr. Kerrie Reed, MD on her blog post at Kevin MD. She wrote “the mere presence of findings on MRI makes both patients and doctors feel obliged to do something even though that something is usually unwarranted.

This realization will come as a shock to the many people who regard the MRI as the Magic 8-Ball of medicine, magically revealing the secret of what ails them. The reality, however, is that an MRI is nothing more than a detailed picture, one with a tendency to add to rather than lessen the confusion of getting an accurate diagnosis. The more detail, the more confusion over what any of it means. For that reason, the MRI is useful only to the degree with which it correlates with other pieces of the puzzle (e.g. symptom details, physical examination findings, and results of other tests). It is no better at providing a definitive answer than is opening up the hood of your car when you hear it making a funny sound. After all, you’re almost guaranteed to find a grimy engine block, a frayed fan belt, maybe a missing radiator cap or any number of other “abnormalities,” but these things mean very little in and of themselves, and may have nothing to do with the funny sound. In fact, they do little more than prompt the same question that most findings on a spine MRI should: “OK, so what?”

The bottom line is that spine MRIs can be very valuable tools but only if ordered for the appropriate reasons, put in proper clinical context, and correlated with other pieces of the puzzle. When it comes to back pain, they’re not the end all be all they’re cracked up to be. They’re barely the end some be some, as the American College of Physicians has made clear. In most cases, MRIs are unnecessary and delay proper treatment; at worst, they lead to potentially harmful interventions. So the next time your doctor declines to order that MRI you requested, know that it’s not some callous attempt to contain costs. Odds are, it’s to spare you unnecessary testing, hassle, risk, and delayed treatment. In other words, odds are it’s just the correct call.”

If you have back pain and live in Greensboro, High Point, Kernersville, Asheboro, Summerfield, Oak Ridge, Jamestown or any of the surrounding areas, please sign up for our newsletter and free eBook or call us at 336-271-6677 to discuss your options.

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  1. David Goildeen
    5 years ago

    Aaron,
    Great article thanks.
    David


  2. Dr. Aaron LeBauer
    4 years ago

    Thanks for your comments and feedback!

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