First of all why do we even take the time or spend the money to get an MRI? No one really enjoys laying in a small tube and not being able to even flinch or sneeze for an hour do they? When it comes to musculoskeletal injuries, typically you are referred to get an MRI if you have pain or any symptoms that can not be explained by an X-ray or that will help your physician examine you without having to open you up under the knife.
The purpose of discussion today is to help you understand what exactly your MRI results say about you and how it can help us as physical therapists treat you and help you get better. Many times I hear patients wondering why they have not yet had an MRI and how can we treat you without the MRI results? The reason is simple, the findings on your MRI are often times not the source of your back pain. Even more importantly, your MRI cannot explain why these abnormalities are occurring in the first place.
Research has shown that more often than not, the results of your imaging are irrelevant in getting you back to full function. A study done in New England took 98 asymptomatic or pain free individuals and did lumbar MRI scans on them. The study revealed 64% of them to have abnormal findings in the lumbar spine. Another study, also using asymptomatic individuals, found that 30% of participants in their 20s had disc bulges at some level of their lumbar spine. The study also revealed that every decade of life, the occurrence of having a disc bulge without any symptoms, went up almost 10%. This means that by the time you are 80 years of age, 84% of individuals will have asymptomatic disc bulges in their lowback.
The case below is an MRI of a 30 year old male firefighter with a history of low back pain. This image was taken after he did several months of physical therapy and weight training. As you can see he has abnormalities at almost every level of his lumbar spine. Believe it or not, at the time of this scan he is pain free lifting heavy weights, fighting fires, and rescuing kitties from tall trees.
The purpose of this article is in no way intended to discredit the use of an MRI. MRI is a great non invasive tool that can be used to rule out serious injuries or life threatening conditions. My goal is to help you decrease that fear factor when you see scary terms such as facet spondylosis or annular bulge on your imaging results.
As therapists, our job is to stop your pain by helping you move better, rather than just slapping a band aid on the pain and letting the wound re-open later down the road. Therefore, many times the results on an MRI will not change the way in which we would treat or establish a plan of care for an individual.
The moral of the story: whether your MRI scan reads multi level osteoarthritis, or an L5 disc bulge, your back pain is not forever!
Jensen, et al. “Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain.” The New England Journal of Medicine (1994) 331:69-73.