One of the most popular questions and concerns I get from clients is whether or not they need an MRI for their back or neck problem. When you have persistent pain that won’t go away, or shooting pain or numbness down your arm or leg, it’s scary. It makes sense to get a look inside with an MRI – right?
Here’s the problem.
MRI’s are an amazing technological advancement that will literally show you everything that is going on in your spine. But what we now know from research is that all those findings on an MRI rarely correlate with what’s actually causing your pain. One notable study was the Lancet series – three published papers that investigated how MRI findings related to the treatment of back pain. Martin Underwood, MD, co-author of the Lancet series, and professor at Warwick Medical School, is quoted in The Guardian saying: “If you get into the business of treating disc degeneration because it has shown up on an MRI, the likelihood is that, in most of those people, it is not contributing to their back pain.”
Let me explain.
When it comes to neck and back problems, what most people don’t realize is that 70-80% of all spine and musculoskeletal problems are what we call “mechanical” in nature. That means that your problem has to do with the way you move, bad postural habits learned over the years, or muscular and joint imbalances like weakness and poor flexibility. Many of these mechanical “wear and tear” problems don’t show up until your 40’s, 50’s or 60’s – which coincidentally is also the time that things like disc degeneration show up on an MRI. Disc degeneration and arthritis are normal parts of aging, but they often get blamed for problems they don’t actually cause. The best way to figure out a movement problem is with… well… movement! Not an MRI.
But how do you know that it’s a mechanical problem and not something more serious?
The easiest way to find out is to ask a physical therapist who specializes in the spine, and specifically in mechanical neck and back pain. But one sign you can easily recognize on your own is to take note of how your pain behaves. Does your pain come and go? Do you have good days and bad days? Can you change positions and influence your pain? When your pain is variable, it’s the best sign that your neck or back problem is “mechanical” in nature and due to a movement dysfunction. And that also means you don’t need surgery or any kind of procedure to fix it! In fact, a procedure or surgery could leave you feeling worse off than before.
So what’s the big deal about getting an MRI? Isn’t it good just to be extra-cautious?
In theory – yes. But here’s what actually happens. MRI’s are super powerful and amazing tools. Because of this, they see everything – including normal age-related changes like I mentioned just a moment ago. They also pick up things like bulging discs.
Research has also shown that around 60-70% of the population walk around with bulging discs and have no symptoms. Why?
Because a bulging disc only gives you trouble if you are moving or positioning yourself in an unbalanced way.
If an MRI picks this up, the news is often more devastating than it needs to be and the typical advice is to get an injection or surgery. Neither of these procedures will fix your movement problem. And what typically happens is the bulge comes back, or appears somewhere else. This is why being “extra-cautious”, and over-prescribing MRI’s when it comes to back and neck pain, is not a good idea. The outcome is usually that people end up dealing with invasive procedures and surgeries they didn’t even need.
If you’ve had a bad accident, fall, or trauma – then an MRI is a good idea. But if you are dealing with chronic, long-standing aches and pains that have come and gone over the years and have recently gotten worse – there is a 70-80% chance that it is a movement problem that has finally caught up to you. It’s best to see a movement expert for this. We know how to tell if the issue is something more serious. We can also send you to a doctor right away if necessary. But when you automatically assume that you need an MRI first, you end up spending a lot of money (the average cost of an MRI is $150,000, and you have to pay a portion of this), and the likelihood of getting prescribed an unnecessary surgery or procedure is much higher.
If this story sounds all too familiar, or you’ve been told that you must get an MRI for your neck or back problem – feel free to reach out to us and we can help you sort through fact vs fiction. You could also come to our next “Ask the PT Night” on October 23rd and ask your questions then!