Ask a Therapist - MRI & Low Back Pain

This week's question is an excellent one and a common issue for quite a lot of people.  The question is, how do I know if I need an MRI or other advanced imaging (such as a CT scan) for low back pain?  People may understandably assume that more pain equates to a more serious issue but this is not backed up in the medical literature.  The medical establishment actually has a guideline for when advanced imaging is appropriate.  Unfortunately, these guidelines are often not followed by medical doctors as demonstrated by this survey given to 579 VA doctors.

“Our study showed that almost all clinicians were aware that an imaging test was not indicated for a patient with low back pain without danger signals of severe spinal problems and agreed with the Choosing Wisely recommendations to not do testing,” Sears told Reuters Health by email. “Instead, clinicians worried about not having sufficient time to explain the risks and benefits of testing to patients, were concerned over medical liability if tests are not ordered or rare diagnoses are missed, and noted that they cannot refer patients to specialists without first ordering imaging, even if they think the imaging will not change patient management.”

So what's wrong with getting an MRI or CT scan if it is not really needed?  Aside from the cost of such procedures, they may lead to addition unnecessary tests/measures which could delay proper treatment and potentially result in worse outcomes.  Perhaps the co-author of the study says it best.

CT scans expose the patient to radiation, which can add up over time, and even without inherent dangers an unnecessary test could reveal an unexpected finding that may be insignificant to a patient’s health but lead to more testing, and sometimes complications, Sears said.  “Patients should first have a thorough history and physical exam to rule out presence of ‘red flag’ symptoms and are often first referred to physical therapy in the initial treatment period,” she said. “Because low-back pain tends to come back, staying active, through activities such as walking, yoga, and supervised training, is key to warding off recurrence.”

Sometimes what we get is a super scary and expensive picture of our insides and it doesn't actually do anything to help us get better.  In general, degenerative disc or joint disease can be likened to getting wrinkles on your skin as you age.  It's natural to some degree.  Sometimes an expensive picture IS appropriate but there are some pretty clear indicators which your healthcare provider should discuss with you.

Understanding this "up-to-date" summary of Low Back Pain is invaluable if you have any consistent back pain.  It reviews the rare but serious conditions that may exist as well as the utility of imaging and when it is or is not appropriate.  That said, we know in medicine that no series of questions will be 100% accurate for everyone in every given circumstance.  The key is to look for the big issues, listen to your body, and visit a healthcare provider who has the training (and the time) to address your issue as well as if it is or is not improving.  How you symptoms change can be just as important as what your symptoms are in the first place.

Therapists are trained to screen for the major problems and if it's the kind of back pain that's not due to a scary cause, we are trained to help you improve symptoms, mobility, and other factors that may have led to your episode (i.e. muscle imbalances for examples).  Check out these articles/studies on this topic here, here, here, and here.  It's also true that people can spontaneously recover from back pain with time and as long as they remain active.  Our bodies are pretty smart.  That said, some people have a more difficult time than others and might benefit from getting professional help.  In the end, therapy seeks to improve movement and quality of life whereas an MRI or CT scan seeks to find out if you're a candidate for spine surgery (or other serious treatment such as chemotherapy if your pain is caused by a tumor).

Thanks for the thoughtful question this week and keep them coming.  Please share our Facebook page and this blog with friends and family.  Submit general questions by Facebook messaging "Natural Performance Rehab, LLC" or via email at npremail@naturalperformancerehab.com