Do I need an MRI for my back pain?

​Low back pain is one of the most common reasons that people seek care.  Often times this pain has no known original injury, or the “original injury” happened so long ago that it can’t exactly be blamed for the long term back pain that someone might be experiencing since.  A commonly asked question by patients coming in to physical therapy for their low back pain is whether or not they need some sort of imaging- a radiograph (Xray) or MRI.

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Old Fashioned Medicine

​Until recently, it was fairly common practice to obtain some sort of imaging of someone’s low back if they were experiencing pain.  But in 2015 there was a study published in the American Journal of Neuroradiology (I’m sure you all got it, you all subscribe to this journal right? Ha!) that looked at MRI imaging in people without a history of back pain.  The goal was to determine how common “abnormal” MRI findings are in people without low back pain.

​What this table tells us is that some “abnormal” MRI findings are really not so abnormal after all!  Specifically, if we look at the first row- Disk degeneration- even by age 30, over half of people will have this finding on an MRI of their back despite the fact that they do not have low back pain.  Even more interesting, if we look at the row for disk bulge, we can see that by age 40, half of the people studied had at least one bulging disk, without any pain!

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Scary?

​A lot of the findings in this table sound really scary and can sound worrisome when you already have back pain and you see the report with some of these words on it.  This study tells us, though, that any “abnormal” findings on your MRI might have been there long before you began having pain, and might have nothing to do with why you are currently having pain.  So when your physician or physical therapist tells you that you do not need to have a radiograph or MRI of your low back, it is likely because they don’t see any clinical signs that we would see anything on that image that would change your course of care.  Physical therapists across the country, and probably around the world, will tell you that we can very successfully treat your low back pain without ever having any sort of advanced imaging.

Get PT First!

​If you are having back pain, the best thing to do is to call your nearest Altitude Physical Therapy clinic and get set up with a physical therapist who can evaluate your symptoms, your movement patterns, and come up with a plan to get you back on your feet.  And we’ll likely do it without needing any sort of imaging!

Author

Heather Shaughnessy, PT, DPT