MRIs: To scan or not to scan?

MRIs: To scan or not to scan?

As physiotherapists, we get asked this question often, especially from people who suffer from lower back pain.

MRIs: To scan or not to scan?

Our guest physiotherapist, Josefin, has this to say about MRIs.

When we are asked about MRI scans and the necessity of getting one, most of the time, we would say ‘No’. Here’s why:

An MRI can cause a false alarm. If you have recently had a lower back scan, you may know what I mean. A few pages of foreign terminology and it all sounds overwhelming and, quite frankly, quite scary. What’s a disc herniation, or stenosis anyway?

Your first thoughts are, ‘This must mean surgery!’ But again, the answer is ‘No!’ Scans are very detailed and will report anything that the radiographer can see on the imaging, and these are not necessarily related to your symptoms.

The truth is that most people will have something ‘wrong’ with them if you scanned their backs. This is caused by the natural ageing process, like getting grey hairs, or wrinkles developing over time.

The severity of the pain can be very debilitating, and you think that you need that scan to determine the cause of your pain. It’s worth remembering that MRI scans do not show pain. A recent research study of people with no back pain having undergone an MRI demonstrated that a large proportion had disc degeneration, disc bulges/protrusions, facet joint degeneration and so on from as early as the age of 20! Gulp!

At the age of 80 or over, 96% had disc degeneration – just like grey hair! So in the end, the MRI leaves you no wiser as to the cause of the pain. Someone with no pain can have the same MRI results as someone else with severe back pain.

For example, let’s say it has been decided that your pain is likely to be caused by one of your discs – so what? Physiotherapy is still the first point of call, and it’s only when conservative management over a considerable time has failed (and there are no alternative options) that I would recommend surgery.

Of course, there are times when an MRI is useful and will help to determine the management of your back pain, but this is commonly associated with severe nerve root pain. You will have other symptoms like pins and needles, numbness and weakness or compression of the spinal cord or you would probably not be responding to conservative treatment (physio) at all.

In conclusion, back pain is a complex interaction between lots of different factors which all need to be considered for you to get better. An MRI isn’t always the window into the um… back.

This post first appeared on the Get the Edge website.