Why An MRI Isn't Always The Answer (Or Other Medical Imaging)

You are not a sum of your medical image! As a physical therapist, all too often I see people overly concerned with a finding that a medical provider told them about on their medical image (X-ray, CT, MRI, etc.).

Something to consider is that the area of pain (i.e. the victim) isn't always the culprit or the true cause of the issue. In the event of a crime, who is the one that screams? The criminal or the victim? In most cases, it's the victim. The same can be said for many painful musculoskeletal conditions (common ones being low back, neck, shoulder, and knee pain). In a case of low back pain, there is often an issue of over utilizing the lumbar spine and the structures of the low back. It's not always the case that you have a "bad" back - just that your back has been asked to do a job that it was not necessarily designed to do. There are countless ways to perform our daily movements. Our brain and body are incredible at compensating for movement dysfunctions. This is a great adaptation in the short term. However, long term, this is what can lead to low back pain that has gradually progressed over years and years before even becoming painful or noticeable. Specifically with low back pain, it is often the thoracic spine (the middle of your back) and the hips that are not moving as well as they should (i.e. stiff/tight), which leads to the low back making up all of the motion when we go through our daily tasks.

The other thing to consider is that we want to avoid over-medicalization of some of these injuries. Using low back pain again as an example, it is rarely caused by something that needs to be addressed medically. In fact, the majority of musculoskeletal conditions (including things like back pain, neck pain, shoulder pain, knee pain, etc.) do not necessarily need true "medical" management (things like medications, injections, and surgery). It is more an issue of conditioning, strength, and optimizing movement of other body regions.

The first line of "medical" management for these conditions is typically a course of anti-inflammatory medications followed by potential steroid injections. I'm not suggesting these things are never helpful, because they definitely can be. However, in isolation, they are not at all addressing what tends to be the cause of these conditions - again, things like strength and resilience of body tissue. These treatments simply take the edge off the pain for a short time. Essentially, they act as a band-aid for the symptoms. Unfortunately, this is when we can run into issues with people becoming addicted to pain medications, including opioids, which is another negative consequence of over-medicalizing these problems.

This is of no fault of the providers - medical providers will try to help you however they can within their domain. Medical providers are often in the profession for that very reason; to help. However, most people have a frontline provider as a physician - typically a medical doctor (MD) or doctor of osteopathic medicine (DO). Medical doctors practice...guess what?....medicine. That is how they know best how to treat conditions and therefore that is typically the first line of defense. Our current healthcare system is not quite set up to get you to the appropriate provider for your condition right away, unfortunately.

Don't Be Fooled

Another example of the harmful effects of over-medicalization and imaging is how the information is presented and/or received. The findings on these images are often incidental and do not relate to the cause of your symptoms, similar to how we just discussed how the victim (painful area) is not always the cause. It is rare that you have a previous (and fairly recent) medical image to compare a current one to because people typically only go to the doctor or other medical provider when they have an issue of concern. For this reason, it is difficulty to say with any degree of certainty that these findings "caused" your current condition. The findings may have been there for years, even decades, but you have only have had pain/issues for a couple of months. Yet, because you only receive imaging when there is an issue many people automatically assume that it is relevant when statistically, it isn't likely.

The medical terms attributed to findings on these images are often scary sounding, which can have a negative effect on how you view your body as well. Degenerative disc disease, degenerative spinal arthritis, and spinal stenosis are all examples of medical terms that are more prevalent with age, but rarely present an immediate health threat. Can they play a part in your low back pain? Absolutely - but the truth is that beyond a certain age we all have these things whether we are in pain or not. They should be thought of as "wrinkles on the inside" versus harmful conditions that need surgical correction. You also do not have to be as old as you might think, either. Consider this study in this Instagram post graphic, where over 1/3 of individuals in their 20's WITHOUT SYMPTOMS have degenerative disc disease on an MRI.

How Can I Help?

My practice, Revolution Performance, provides you education and guidance on these topics and many more in a PROACTIVE model. This way you have the knowledge and tools in place to address whatever issues come your way without the harmful side effects that come with medications, injections, and surgery. Heal the natural way with us!

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Medical Disclaimer: All information on this website is intended for informational and educational purposes only. The authors and partners are not responsible for any harm or injury incurred. It is important to seek professional guidance about your condition or injury. No guarantees have been made or implied regarding specific results of the services described.

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