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To MRI or not to MRI


To MRI or not to MRI, that is the question.


It’s a common one too.


But it’s typically not a hard one to answer.


Let’s break this down in a way that hopefully helps you decipher the overly complex world of the MRI. For this blog, I’m talking about MRI’s of musculoskeletal injuries. As a physio, I can’t and won’t speak to imaging for other medical issues not involving the musculoskeletal system.


So if you’re wondering if you need an MRI, you need to ask yourself these questions FIRST.

  1. Do I have red flags? (symptoms indicative of a more serious problem).

This could include things like the following:


  • -loss of bowel or bladder control

  • -unusual heat in a body region

  • -night sweats or night pain that is not position dependent

  • -numbness in your groin area or around your genitals

  • -recent mechanical trauma (car crash/football tackle) or inability to bear weight on a leg/arm

  • -dizziness or unusual clumsiness of your hands/legs


There are many other red flags out there but you get the point. If you’re thinking to yourself “this is really strange and abnormal” then you may need some imaging. In these cases saying “YES” to an MRI is likely necessary and you should see your medical doctor.


2. How long has this injury been going on and have I done anything about it?


Outside of significant trauma, MOST acute injuries do NOT need an MRI.


Although these injuries may be unbelievably painful that does not mean there is tissue damage or need for any imaging.


Interestingly enough, this is when most people immediately jump to an MRI without seeing a rehab expert first. There are several things wrong with this thinking.

  1. Acute injuries are often the easiest to rehab if started early

  2. Most acute injuries are non specific (meaning an MRI is useless) and heal without need for further medical intervention

  3. An MRI is not treatment for your injury, only an investigative image (it doesn’t put you any closer to your goals)

If you have an acute injury and don’t start by seeing a rehab expert, you’re putting the cart before the horse. A good clinician will be able to help you navigate the world of imaging if it’s appropriate for you.


More than likely your injured tissue can be addressed with activity modifications, manual therapy, proper loading, and time.


If this is you. NO, you likely don’t need an MRI.


3. Am I 100% committed to surgical intervention?


This one gets me. I see it all the time.


Patient’s will get an MRI first and then schedule their rehab. They’ll be adamant that they don’t want surgery.


I’ll often ask them “Then why did you get an MRI”?


Typically the answer is some version of “My Doctor told me to” or “I didn’t know what else to do”.


This is frustrating as a PT for several reasons. One being that the cost of an entire PT plan of care is often less than that of a single MRI.


A good PT plan can help you get out of pain and crush your goals while an MRI is just a picture of your tissue. Basically in many cases it’s a HUGE waste of money.


Patient’s will throw money away for a picture that doesn’t help them solve their problem but scoff at the idea of paying a professional to help them solve their problem. Get’s me every time.


Secondly, it’s frustrating how poorly PT’s educate their community on how effective PT can be for many conditions. People don’t know where to start and it’s 100% our fault (rehab professionals). We’ve got to do better, myself included. We have the research to support this.


A recent study in The International Journal for Quality in Healthcare found that in acute injuries MRI’s are grossly overprescribed. They found that in over 30% of individuals with knee and shoulder pain and over 60% of those with back pain that MRI’s were medically inappropriate and unnecessary.


This is one reason why the US spends over 100 billion dollars a year on imaging.


Yikes.


If you’re 100% ready for surgery, then go for the MRI. If not, seeing a good rehab clinician is a MUCH more appropriate place to start and may just save you a lot of money and headache.


4. Can you mentally handle the findings?


This is a biggie, so let me expound.


The medical imaging model too often treats humans like we’re machines. Find the broken piece, replace it or fix it, and the problem is solved right?


Unfortunately, it’s not so easy.


Humans are not cars and can’t be treated as such. Our bodies are connected to our brains which makes injury, pain, and recovery an entirely different beast.


The good thing about an MRI is that it will reveal any tissue abnormalities.


The bad thing about an MRI is that it will reveal any tissue abnormalities.


This can be very confusing and have negative consequences for a lot of people.


Here’s why:


  1. -A static picture does not tell the whole story of pain generation. Especially if that pain happens in a dynamic motion (running, lifting, etc.)

  2. -A huge number of healthy people without pain have significant abnormalities upon imaging (rotator cuff tears, bulging and herniated discs, meniscal tears, etc.)

  3. -Learning about a specific tissue injury can cause certain people to fixate on that injury thus making recovery harder.


In an interesting study done in 2019 in the BMC Journal of Musculoskeletal Disorders, they found that individuals that had an early MRI for back pain had a longer length of disability than those who did not. They had higher levels of disability and work related disability.


If you don’t have the medical context to help you process MRI findings, you likely do NOT need an MRI. Again, instead find a local rehab provider that can help you navigate your specific injury.


I hope this is helpful in navigating this topic.


These things are always managed best in relationship with a real, in person healthcare provider.

If you have a musculoskeletal injury, the best FIRST step is almost always seeing a physical therapist.


A good PT does not need imaging to do a thorough clinical exam and give you good advise for your specific injury.


If that’s you, contact me and we’ll chat. I spend hours every month talking with folks on the phone who don’t know where to start. I’ll do the same for you.


As always, Stay Kinetic Friends.



References:


1. Shraim BA, Shraim MA, Ibrahim AR, Elgamal ME, Al-Omari B, Shraim M. The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis. BMC Musculoskelet Disord. 2021 Nov 24;22(1):983. doi: 10.1186/s12891-021-04863-9. PMID: 34819061; PMCID: PMC8614033.



 

Dr. Levi Kerby is a physical therapist, orthopedic certified specialist, and owner of Kinetic Performance and Rehab in Winston-Salem, NC. He enjoys fly fishing, guitar, various forms of fitness, and treating active and motivated individuals.


If you're dealing with an injury or pain, you can contact Kinetic Performance and Rehab directly below.




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