spine Last week, I touched on a case of great concern to me regarding a man named Ronnie who had neck surgery prior to receiving any physical therapy treatment. If you haven’t read it yet, I invite you to check it out here. That particular article is a great transition to an issue that many have little understanding about - What is the relevance of Magnetic Resonance Imaging (MRI) on people suffering from back and neck pain? There are many studies out there highlighting the lack of significance of these types of images, and here are a few: One study found that overutilization of MRIs in patients with low back pain correlates with, and likely contributes to a 2 to 3-fold increase in surgical rates. Though lumbar MRI’s are being performed more frequently, there is no correlation with improved patient outcomes. The same study also highlights that a patient’s knowledge of imaging abnormalities can actually decrease self-perception of health, and may lead to fear avoidance and catastrophizing behaviors that may predispose people to chronic back pain.1 Another study published in Spine revealed MRI findings of disc protrusion, nerve root displacement/compression, and disc degeneration are all associated with LBP, but individually, none of these abnormalities provides a strong indication that LBP is attributable to underlying pathology.2 A study in The New England Journal of Medicine performed MRI examinations of 98 people without low back pain and 27 people with back pain (to reduce possibility of bias in interpreting the results). The results of the study found only 36% of the 98 asymptomatic subjects had normal disks at all levels. 38% had an abnormality at more than one disk. This means that many people without back pain have disk bulges or protrusions and that these types of MRI findings in symptomatic individuals may purely be coincidental.3 A similar study was performed for the cervical spine and determined the same outcomes, including posterior disc protrusion and even compression of the spinal cord were not rare in asymptomatic subjects over 40 years of age.4 What does this all mean? To sum it up, an MRI can be detrimental to your prognosis when dealing with low back and cervical pain. Just because an image shows an abnormality, doesn’t mean that it’s the CAUSE of your pain, and there is no way of knowing how long the abnormality has been there. The truth is, these types of images rarely offer any insight into WHY you are having back pain. However, a physical therapist can perform an examination and tell you WHY your back or neck pain is occurring, put you the appropriate treatment plan to address it, and fix the REAL problems that are causing the pain. Rather than going to a chiropractor, surgeon, or pain management doctor, the safest and most effective first step to treating back and neck pain is a consultation and evaluation with a physical therapist. The safest bet is to GET PT 1st!!!
  1. Timothy W. Flynn, Britt Smith, Roger Chou. Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good. Journal of Orthopaedic & Sports Physical Therapy 2011 41:11, 838-846
  2. Endean, Alison,) Keith T Palmer, and David Coggon. Potential Of Mri Findings To Refine Case Definition For Mechanical Low Back Pain In Epidemiological Studies: A Systematic Review. Spine 36.2 (2011): 160–169. PMC. Web. 22 Mar. 2016.
  3. Jensen, Maureen C., et al. "Magnetic resonance imaging of the lumbar spine in people without back pain." New England Journal of Medicine 331.2 (1994): 69-73.
  4. Matsumoto, Morio, et al. "MRI of cervical intervertebral discs in asymptomatic subjects." Journal of Bone & Joint Surgery, British Volume 80.1 (1998): 19-24.