Will Getting an MRI Help My Back Pain?

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.

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