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I have often been asked throughout the years if a patient should get an MRI for back or neck
pain. You would assume that if you want a better idea of what’s really going on, then you
should get a more detailed image, right? Not necessarily. In fact, getting an MRI can cost you
more than just the initial several hundred dollars. What do I mean? Let’s investigate!
First, we need to define an MRI and understand what it provides. A magnetic resonance image
(MRI) is potentially the most detailed picture we can get of your body. It has strengths and
weaknesses depending on what pathology you are investigating – but it is a safe bet that there
isn’t much an MRI can’t see. This can be a problem, though. What if that bulging disc showing
up on your MRI has actually been present long before your new back pain? Or what if the
“problems” we just found aren’t problems at all?
There have been several studies that have come out over the past few years investigating false-
positives on an MRI. Basically, this means the MRI has showed something that looks like a
problem, but in reality it is not. For instance, in a study by Matsumoto et al (1), researchers
found signs consistent with cervical (neck) disc degeneration in 17 percent of people in their
20s and in 86 percent of people over 60 years old. This wouldn’t be surprising except for the
fact that none of these participants had any pain at all.
Another study by Brinjikji et al (2) looked at the lumbar spine and determined that among
people in their 20s, 37 percent had “spinal degeneration,” and 30 percent had the infamous
“bulging disc.” Guess how many had pain. That’s right, none. Hold on just one minute, here,
Ryan. You’re telling me that these MRIs showed degenerative changes and disc bulges in the
youngest and healthiest participants and that they had absolutely no pain? That’s correct. This
continued in relation to age and showed 96 percent prevalence of spinal degeneration and 84
percent disc bulge in those participants over 80 years of age.
This can be tough to process at first because it is so shocking. To clarify, both of these studies
examined thousands of people and found that “degeneration” and “disc bulge” were highly
prevalent – and none of these people had any pain.
So you may be asking, “O.K. sure, but what’s the harm in getting an MRI, even if it isn’t
completely accurate?” This is a great question! Thankfully, it has also been studied. In a study
by Webster et al (3), researchers found that in people with low back pain who had an early MRI,
their prognosis was worse than people who didn’t get an MRI. So this means that getting an
MRI can actually cause more limitation and delay your recovery. We don’t have time to get into
pain science and imagery for this blog post, but understand that the brain is incredibly
powerful, and sometimes getting an image can actually be detrimental to your recovery. Not to
mention that you are shelling out hundreds or thousands of dollars for an image that probably
won’t tell you much useful information. Or, worse yet, that can encourage an unnecessary,
early surgery for a problem.
What are we to do then? Should MRIs ever be used? Yes, they most certainly should. In fact,
the Annals of Internal Medicine published its recommendations in 2007 (4) in regard to MRI for
back pain. It recommended that most patients NOT get MRIs for general low back pain, unless
they have “severe or progressive neurological deficits...or suspect serious underlying
conditions.” So, unless you have severe or progressive weakness or numbness, or are at risk for
a serious underlying condition such as cancer, you should not be getting an MRI for your back.
The recommendation was that the only reason to get an MRI outside of these reasons is for
surgical candidates. Unless you are looking at getting surgery, an MRI likely cannot help you.
You may be feeling a bit frustrated at this point because it appears that the Superman of
imaging cannot help get to the bottom of your back pain. I understand your frustration. But we
have to understand that if we take a super-powered microscope to any structure, we will find
problems. Does that mean the structure cannot continue to function without issue? Of course
not. In fact, disc degeneration, bulging discs, narrowing and the like are very, very common. In
fact, I like to refer to them as “wrinkles on the inside.” As we age, we all get wrinkles. Do they
hurt? Of course not. Let’s start looking at these back issues in the same way.
One last thought for you before we close up this already-too-long blog post. Two groups of
researchers looked at disc disruption/herniation/bulge and natural recovery. They found some
surprising results. Zhong et al (5) found that among patients with a lumbar disc disruption, 67
percent spontaneously resorbed. It got better all by itself! And Elkholy et al (6) found that the
worse the disc problem, the more likely it was to spontaneously fix itself. Perhaps the body
realizes that small disc bulges aren’t that big of a deal, and it would rather save energy to fix the
“big herniations.”
Well then, what are we to do about your back pain? After reading this blog post, you may think
twice about getting an MRI. Now, to be clear, there are certainly indications for getting an MRI.
But those conditions and circumstance are few and far between. Most often, getting physical
therapy and correcting underlying problems can solve your back pain.
Want to talk more about your back pain? Contact me today, and I’ll be happy to discuss.
Thanks for reading,
Ryan
#PrecisionPT #running #Precisionpt #precisionperformanceATL #physicaltherapy #atlantaphysicaltherapy #runningdoc
Sources:
1. Matsumoto, M., Fujimura, Y., Suzuki, N., Nishi, Y., Nakamura, M., Yabe, Y., & Shiga, H. (1998). MRI of
cervical intervertebral discs in asymptomatic subjects. The Journal of bone and joint surgery. British
volume, 80(1), 19-24.
2. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Wald, J. T.
(2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic
populations. American Journal of Neuroradiology, 36(4), 811-816.
3. Webster, B. S., Bauer, A. Z., Choi, Y., Cifuentes, M., & Pransky, G. S. (2013). Iatrogenic
consequences of early magnetic resonance imaging in acute, work-related, disabling low back
pain. Spine, 38(22), 1939.
4. Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., & Owens, D. K. (2007).
Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of
Physicians and the American Pain Society. Annals of internal medicine, 147(7), 478-491.
5. Ming Zhong, M. D., & Liu, J. T. (2017). Incidence of spontaneous resorption of lumbar disc herniation:
a meta-analysis. Pain physician, 20, E45-E52.
6. Elkholy, A. R., Farid, A. M., & Shamhoot, E. A. (2019). Spontaneous Resorption of Herniated Lumbar
Disk: Observational Retrospective Study in 9 Patients. World neurosurgery.