You are NOT your MRI – MRIs for Low Back Pain Can Cause More Harm Than Good

If you haven’t seen the videos of me (Mike) recently, I’ve been treating patients in China these past few months of early 2017. Sadly, the people here have an extremely low level of education and understanding of their health. Everyday in the clinic, we battle not just construed cultural enigmas (“my back hurts because of the cold wind”), but also improper education/advice  (“my doctor told me if I do anything more vigorous than walking my nerve will impinge and I will be paralyzed”). One of the biggest reasons why Craig, Arash, and I started The Prehab Guys’ in the first place was to inject some truth and science into the fitness and health industries. Proper education on your movement system, from why you experience pain to self-management strategies, GO A LONG WAY in making this world a much better and happier place. Education is power. Without further ado, fact #1…

you are not your MRI

 

YOU ARE NOT YOUR MRI!

MRIs for low back pain, especially when it comes to musculoskeletal low back pain, are not just useless – they can actually cause more harm than good.  If you and I (both healthy individuals) had an MRI, I can almost guarantee our results would AT A MINIMUM read something along the lines of “mild degenerative changes at L4-5”. Or even “slight disc buldge at L3-4”. Does that mean I can’t walk and my back aches for days? No. If my back does start aching, does it mean it’s from my “disc buldge”? Probably not. And could more likely be explained by sleeping in the wrong position one night or not properly hip hinging while deadlifting yesterday. Just because there are “findings” on an MRI, it does NOT mean that’s the cause of your low back pain.

MRIs for low back pain

I hate to break it to you, but that MRI shouldn’t dictate or influence ONE BIT how your physical therapist manages your pain. Because guess what, you and joe schmo can have the same exact MRI findings, but Joe could be in 10/10 pain while you feel like you could do a triathlon. A physical therapist will treat YOU. And YOUR clinical presentation. What things make YOU feel worse or better. What impairments YOU have. What movements YOU need. Not what an image shows, as everyone’s MRI will undoubtedly show something.

 

Now, don’t get us wrong – MRIs definitely have a time and place and are a useful tool in ruling out the big bad uglies like tumors or true spinal cord compression. However, many people run to get an MRI the moment they are in a little bit of discomfort. It’s ruining our healthcare system – financially and socially. And when we healthcare providers fail to educate those on their findings, we’re failing our patients. Don’t the words “degeneration” or “disc bulge” sound daunting, definitely if you’re a relatively fit 35-year-old? If we don’t educate the public on radiographic/MRI findings, it’s natural to feel scared, and become fixed on your imaging and consequently loose up. It’s a downward spiral for many.  This is why MRIs for low back pain – without proper education – can cause more harm than good.

 

To sum it up, here’s a direct quote from a major 2014 review by Brinjikji et al: “signs of degeneration are present in very high percentages of healthy people with no problem at all. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”

 

MRIs for low back pain

 

13 thoughts on “You are NOT your MRI – MRIs for Low Back Pain Can Cause More Harm Than Good

  • Question is: how can you discern whether they have a legitimate lower back problem or not?

    Does it mean that the proper cure for lower back pain is almost invariably core stability , proper alignment and hip & thoracic mobility?

    What do I tell people as a personal trainer who specializes in fixing musculoskeletal dysfunctions, but doesn’t have the scope of a physical therapist?

    • As a Doctor of Physical Therapy, we are trained in screening for red flags – true medical problems and know when to refer out. As a personal trainer, if someone is in pain, you should refer them to see a physical therapist or other health care professional. Don’t do anything your professional license does not allow.

  • This is excellent information that you synthesized very well. Thanks for that! However, there are multiple grammar issues and words missing in multiple sentences that make this very useful article hard to read. Please correct so that I can use this for patient education.

  • I recently (9 weeks out) had a microdisectomy on my l5-s1 disc. I’m an active firefighter/ golfer and do CrossFit. As far as rehab and long term health career wise what can I be doing to “pre- hab” my back from now on. Thanks for the great videos and info.

    • Sounds cliche, but move. Get back to doing all the things you used to do, without fear you are hurting yourself. Work with a physio on proper movement mechanics…especially for golf and crossfit. Lots of repetitive movements so you want to ensure you are doing everything right. From a golf standpoint, hip mobility is huge. especially lead hip IR. Prehab is individualized so its best to see someone in person who can tailor a plan directly for you. We do offer online prehab consultation in which we can make a plan together if that’s something you would be interested in.

  • MRI is a technology that is used to see detailed image of the body’s soft tissue and bones that are damaged. It scans the spine by using a magnet that goes around the body. Being an expert of it, I am sorry to disagree but it is not harmful as you are saying. It is approved as a very helpful for curing spine issues.

  • Big fan of the prehab guys and really like this article as just the beginning of the topic. Unfortunately the “cold wind” you mention can cause back pain. When a person has central sensitization with temperature allodynia, a cool breeze could certainly be perceived as pain. Dismissing someone’s claims of pain can be just as detrimental as incidental findings on an MRI. You and your patients could benefit greatly from some pain neuroscience education.

  • This is an interesting article. I’m 31 and a few years ago I was having left leg pain and tightness. I’ve been doing crossfit for 4 years, and played college basketball and soccer. The outside of my thigh was constantly aching when doing squats with weight. I couldn’t sit for long periods or my left leg would start hurting and tightening up. I initially thought it was a hip problem. Finally when I had an MRI followed by a CT the images indicated bilateral spondylolysis, and spondylithis of my L5, with a grade 1 slip. I thought to myself, how? I didn’t fall, and I don’t know how it happened. I was told several things. Do Pilates and avoid CrossFit. One wrong move, and you can become paralyzed if there is more slippage. I was also told I can do crossfit, but be mindful with form which I already am. I continued to do crossfit, and i have my good days and bad. Some days I have sciatica like pain, and other days I feel great. I do core stability work, unilateral work, and take my recovery days. My only existing complaint is My left leg hasn’t really developed enough strength in comparison to my right after focusing on unilateral. Other that, it’s been better after diagnosis and recommendations.

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