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Back Pain Sufferers – You are not your MRI

Roughly 4 out of 5 people experience concerning back pain at some point in their lives. Being able to solve this pain and find relief can be challenging. Those who have experienced back pain can attest that it can quickly become debilitating such that it interferes with daily activity.

In today’s healthcare system, those with low back pain can find themselves spiraled into a routine process of elimination. This prolongs their time in pain and has minimal impact in reducing the high recurrence rate of back pain. Prescriptions for “muscle relaxers” or advice to “rest” can sometimes be administered. Similar messages in the workplace can be delivered to employees of “lifting restrictions”, so as to not further damage their back. But where will those well-meaning prescriptions lead individuals? Especially when the advice is being followed without education for best options?

Incomplete advice unfortunately does not resolve or reduce back pain symptoms. In the event the aforementioned advice is ineffective it can progress to an order for radiographic images, such as MRI. Alas, the cost for an MRI in many regions has increased 3X from eight years ago and now can exceed $3,000 for a single MRI order. Another cost consideration is that of time. MRIs do not provide treatment to solve the problem they peer into for the extravagant cost.

MRIs are a marvelous gift in healthcare when used appropriately. However, as with any powerful technology, it can be misused. The internet is a clear example of technology that has brought about much good, and much abuse as well. MRIs can be equally abused when used prematurely to prescribe unnecessary surgery or label a patient.
According to expert research published within the past 5 years, the image delivered is not telling the entire story. Maybe you have heard about “disc bulging” or “disc degeneration”. Degenerative changes in the spine are a common and a relatively normal part of the aging process that doesn’t necessarily mean anything is “wrong” in the back. Another way to put it is that correlation of a bad MRI image and the incidence of back pain does not mean the problem seen in the image is the cause of the pain.

Brinjiki et al in 2015 took an MRI sample of over 3000 pain-free individuals ranging in ages from 20-80 and found that 80% of them had “disc degeneration”. It is worth noting that these people had no pain to report, prior to or following the imaging. So the question is, does degeneration seen on the MRI relate to your back pain and that there is something “wrong” with your spine?

The previously mentioned study sampled a wide span of ages in their group. Thus, it is helpful to break the study down by age demographics to demonstrate that disc degeneration can happen across a lifespan without any signs of pain. In the Brinjiki study, the following statistics were reported:
– 20-29 year olds: 37% showed disc degeneration, 30% had disc bulging
– 50-59 year olds: 80% showed disc degeneration, 60% had disc bulging
– 80-89 year olds: 96% showed disc degeneration, 84% had disc bulging

To be succinct, the focus of this article is particularly on the lumbar spine. Recognize, however, that degenerative changes are consistent across multiple body regions and joints. This research tells us that It would be more abnormal for there to be “no pathology” in an MRI image than it would be to see degeneration on an MRI.

MRI’s are an essential diagnostic tool to diagnose pathology when used in combination with a comprehensive history taking and physical examination. Even so, your movement and your pain response to that movement often tells a greater story than an MRI image can alone. We are advocates for progressive healthcare by starting with thorough history taking and physical examination to determine if an MRI should be sought after. All cases in physical therapy vary and require individual diagnostics to determine optimal route of care. Keep in mind that one size does not fit all and that diagnose before you prescribe is a natural law that should be followed.
Consider an ideal scenario where you could receive full diagnosis and treatment through mechanical therapy for less than half the cost of an MRI. This ideal scene can occur in approximately 80% of all back pain conditions, saving money, time and eliminating pain for a longer haul.

Take a moment to observe this image shown in a short article from the New England Journal of Medicine. The article described a 29-year-old woman with new-onset right leg pain and paresthesia. There were no bowel or bladder symptoms.

Magnetic resonance imaging (MRI) of the lumbar spine revealed a lumbar disk herniation resulting in substantial spinal stenosis and nerve-root compression. The 29 y/o patient elected conservative treatment with physical therapy and an epidural injection of glucocorticoids.

Compellingly, a second MRI at 5 months showed resolution of the herniation. Images are powerful and repeatedly speak louder than words. The results seen in this article are cause to pause and reconsider most effective diagnostic and treatment options. Instead of MRI and surgery being considered as front line options, mechanical diagnostics and treatment in conjunction with physician prescribed modalities can lead greater than 4 out of 5 people to a quick, cost-effective and lasting resolution of pain.

Mechanical physical therapy can significantly reduce or abolish back pain symptoms without the need for MRI, due to an evidence-based systematic approach to correcting movement to restore function. If you have been frightened by your back pain or MRI results, take courage. Maybe you have a sense that there is nothing you can do about your back or that your spine will catastrophically fail if you don’t act quickly with surgical intervention. There is good news regarding your concern(s) as outlined in this article.
We understand the difficulty of navigating through low back pain and finding solutions. The knowledge to skillfully heal a low back injury is critically important. All Wright Physical Therapy clinicians are trained at the highest levels of orthopedic specialty and mechanical therapy to empower you with knowledge to heal. Check out our website at wrightpt.com or call us at one of our convenient locations. We will put you in touch with one of our experts so you can get to the root of your pain now!