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How Back MRI’s Lead to more Invasive Treatments and Surgery

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If you’ve ever suffered from acute or long-standing back pain, you’ve likely wanted to “see inside” and know what’s going on. If this is you – you’re not alone in your thinking – and many medical doctors agree with this approach. However, evidence suggests that unwarranted MRI’s on your back can lead to unnecessary invasive treatments and surgeries, which often result in more harm than good in the long-term.

Let’s take a look at the research.

As part of their International Choose Wisely Campaign, the BMJ (British Journal of Medicine) published findings of a 2020 study that investigated what happens when back pain sufferers get MRI’s done too early (defined as less than 6 weeks into an episode and absent of any red flags). In more than 400,000 patients, those who received early MRI’s on their back were more likely to undergo back surgery and be prescribed opioids. And worse – they had higher pain scores at 1-year follow-up than those that didn’t get an MRI. This is not an isolated study. There is mounting evidence that indicates when MRI’s are done too early or unnecessarily – it leads to more surgery, more invasive treatments, more negative perceptions and catastrophization of spinal conditions, and overall – poorer outcomes.

So when is a back MRI needed? 

When you’ve got any alarming symptoms (known as “red flags”) you should absolutely get an MRI. These include signs of cancer, infection, inflammatory disease, possibility of fracture, or severe neurological deficit. Qualified health care practitioners are trained to identify these red flags. However, they are seen in only about 5-10% of all back pain cases. For context, in my two decades of treating patients with back pain, only three had these serious symptoms. This isn’t to downplay severe back pain cases, but to emphasize that most back pain patients don’t need an MRI for a proper diagnosis and treatment plan. And if you get an MRI when you don’t need one – you might end up with unnecessary treatments or surgeries, be prescribed opioids, and are likely to feel generally worse about your back pain.

The problem with relying on back MRI’s

When you get an MRI of your back – the problem is it shows you everything.

You’ll see a comprehensive view of bulging discs, arthritis, stenosis, and degenerative discs – which are all common findings – but also a normal part of aging. Everybody gets them whether you have back pain or not. But because we haven’t done a good enough job of normalizing these findings – they often get blamed for your back pain when seen on an MRI. But the research shows you can’t reliably correlate your MRI findings to the true cause of your back pain. In fact, they’ve compared MRI’s of people with and without back pain and found they can share almost identical results. In a set of publications known as the Lancet series, Martin Underwood, MD, co-author and professor at Warwick Medical School, said: “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.”

Confused? I don’t blame you.

The truth is, about 70-80% of all back problems, even sciatica, are considered what we call “mechanical” in nature. Your pain will come and go, you’ll have good days and bad days, and you’ll often feel better with movement. Mechanical back pain cannot be diagnosed by an MRI – it’s diagnosed via repeated movement testing to see what triggers and relieves your back pain. And it’s treated with corrective movement strategies designed to get rid of your pain and keep it gone. If you undergo an MRI for what’s essentially mechanical pain, you risk receiving treatments that are not only unnecessary, but can exacerbate the problem. Remember, you can’t reverse a back surgery. And complications related to back surgery are complicated to treat. You owe it to yourself to exhaust all possible conservative treatments.

If you’ve been suffering with back pain for years, I know it’s frustrating.

Consider speaking to a mechanical back pain expert who can help you accurately determine the root cause of your back pain with corrective movement strategies instead of a back MRI.

Give yourself a chance to resolve your back pain naturally instead of resorting to invasive treatments or procedures.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media group. To get in touch, or request a seat in her upcoming Masterclass for Back Pain & Sciatica – visit her website www.cjphysicaltherapy.com or call 603-605-0402

Shoulder Pain

Neck Pain Not Going Away? 3 Reasons Why

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Over 30% of people report they have neck pain, and of those, 50% will continue to have problems without any real answers or solutions. And during the pandemic, we saw more people becoming generally less active, falling off their routines, and working from home in less than optimal “work stations”. It’s no surprise that people are suffering from more neck pain than usual.

Having been a mechanical spine pain specialist for the last 10 years – and a physical therapist for just over 20 – I can tell you that resolving neck pain is trickier than resolving back pain.

And there are some good reasons for that. Your neck is the most mobile area of your spine – which makes it more complicated to manage – and the muscles in your neck are a bit more fragile than some of the bigger muscles in your lower back. The way you strengthen muscles in your neck can’t be approached in the same manner you might tackle your lower back – for example.

If you suffer from persistent neck pain – there could be several explanations as to why it’s not going away. But the biggest culprit I have found is an inaccurate diagnosis. Without the correct diagnosis – your neck pain treatment fails – and it’s more likely you’ll be prescribed injections or pills to relieve your neck pain and get stuck with this treatment regimen for the long-term.

Here are three reasons why the root cause of your neck pain might be getting missed – and why your neck pain just isn’t going away:

 

1. Your neck problem is disguised as shoulder pain:

Shoulder problems are confused with neck problems more often than you would think. If this happens – you risk spending weeks (or months) trying to resolve shoulder pain that is actually a neck problem. Not only will your shoulder pain not fully resolve – your neck pain won’t either – and could actually become worse. Because your neck is so mobile, it’s easy for nerves in your neck to get irritated and refer pain into the middle of your shoulder blade, top of your shoulder, or down the side of your arm. When you consider this, it makes sense why neck problems are so easily mis-diagnosed as shoulder problems. It’s a very common scenario that not only results in neck pain not going away – but persistent shoulder problems too. My general rule of thumb – if you’ve been working on a particular problem persistently and consistently for 2-3 weeks or more without significant improvement – something is missing. You’re either treating the wrong thing or have the wrong treatment approach. It happens a lot with neck pain so be sure to pay attention to this common error – especially if you’ve got coinciding shoulder pain.

2. Your core is weak:

Lack of core strength is commonly associated with back problems – but believe it or not – it can have a lot to do with neck pain too. Most people are familiar with how muscles and joints are connected – but did you know your muscles and organs are connected as well? They’re connected by a web of tissue called fascia – and this connection is often referred to as myofascial. “Myofascially speaking” – your deep neck muscles are connected to your core. If your core isn’t functioning properly – your neck will try to compensate and it will result in neck pain. Do you consistently feel neck pain or tightness every time you do a core workout? This could be a sign that your neck is compensating for your core – and there’s a good chance proper core strengthening is what’s missing. It could explain why your neck pain isn’t going away no matter how aggressively you treat it.

3. The Wrong Neck Exercises:

The anatomy of your neck, more so than the rest of your spine, is fairly intricate and quite mobile. Not only does this require special care and accuracy when it comes to examining your neck, it makes it easy for someone who is not expertly trained to miss things. For example, one of the most common things I see is someone thinking that full range of motion has been restored in your neck when it hasn’t. If you start strengthening your neck when it doesn’t have full mobility, you can run into problems later on that result in persistent pain. Additionally, strengthening the muscles in your neck, especially in a neck that hurts, needs to be done carefully. The muscles in your neck were designed for stability – which is very different from say – the muscles in your legs – which are designed for power. You can’t approach strengthening them in the same way. All too often I see neck strengthening exercises that are too aggressive for the small muscles in your neck. This results in unnecessary neck tension – and delayed resolution of neck pain.

Generally speaking – if you’ve been suffering from neck pain for a while now – and you’ve tried lots of different treatments without any success – there’s a really good chance you’ve been misdiagnosed and have the wrong treatment plan. Don’t settle for relying on pills or injections for the rest of your life. And don’t undergo any kind of surgery or procedure until you’ve truly exhausted all possible causes of your neck pain. Ideally, find a mechanical pain expert who understands the intricacies of neck problems and work with them. If diagnosed properly, it’s not only possible to get rid of your neck pain naturally, but you can learn to keep it gone all on your own.

 

Ready to get rid of your neck pain?

Download 7 Easy Ways to Get rid of Neck & Shoulder Pain written by Dr. Carrie Jose – leading physical therapy specialist and mechanical pain expert in Portsmouth, NH