Sunday, July 31, 2016

Do You Really Need An MRI?

Picture by Cory Doctorow from Flickr
My patient had severe low back pain with some referred sensation of numbness, pins and needles down to the left buttock and hamstring area after her weight training in the gym recently. She went to see her doctor who referred her to a spine surgeon who then ordered a spine magnetic resonance imaging (MRI) to investigate further.

Results show she had a prolapsed disc (PID) or what is commonly as a slipped disc. The surgeon suggested surgical intervention to remove the disc but my patient refused and sought a second opinion.

Subsequently she came to our clinic after her friend with similar findings on MRI (but didn't have surgery) got better after seeing me.

I've encountered some patients who showed up in our clinics with "many problems" on their MRI but no pain while other patients showed no abnormality on their MRI but complain of severe pain. If you "believe" the MRI you may end up treating the MRI and not treating the patient (or trying to fix the problem on the MRI rather than addressing the actual issue causing your patients' symptoms/ pain).

Personally, I believe that nine times out of ten, a competent health care provider (doctor, physiotherapist etc) can pinpoint the cause of your pain/ injury without ordering an expensive MRI.

In our clinics, we ask many questions about the patients' symptoms, training regime (for a sports injury), much like a detective looking for clues. We then do a thorough physical assessment - comparing limbs, palpating the area that hurts, moving your limbs/ joints through different positions or have the patient perform the aggravating movement, checking alignment etc.

Done correctly and accurately, we can often pinpoint the root cause of the problem from the physical assessment and treat it.

It's also interesting to note that everyone is built a little differently and our structures change with age. As MRI's are very sensitive, they can reveal abnormalities that aren't the actual cause of your problems.

A recent review article found 37 percent of 20 year old subjects and 96 percent of 80 year old subjects have evidence of disc degeneration on MRI. The authors concluded imaging findings of spine degeneration are present in high proportions of individuals with no pain. These changes in the spine may be a sign of normal ageing rather than medical conditions/ acute injuries that require treatment.

Here's a common running related example. Another of my patients came to our clinic after seeing a Traditional Chinese Physician, physiotherapist and even saw a surgeon for medial (inside) heel pain and didn't get better. She had been walking more than normal and woke up having to hobble with pain upon setting her foot on the ground. That clearly to me would lead me to check her plantar fascia.

In fact, her surgeon did order an MRI and confirmed what I suspected. He proceeded to give her a cortisone injection (steroid injection) which didn't help. My patient endured the cost and hassle of doing the scan for no good reason.

I treated her twice and am happy to report she's well on her way to recovery.

Don't get me wrong. There are definitely times when a MRI scan is needed. If you've had a Physiotherapist /doctor etc assess you thoroughly, rested, had treatment and still not gotten better then it might be a good time to get an ultrasound scan, x-ray or MRI to investigate further.

What about the first patient who had a PID whom I wrote about at the start of this post? Well, she's back running, weight training like normal. Her doctor was surprised to say the least ......


Brinjkii W, Luetmer PH et al (2015). Systematic Literature Review Of Imaging Features Of Spinal Degeneration In Asymptomatic Populations. J Am Neuroradiol. 36(4): 811-816. DOI: 10.3174/ajnr.A4173.

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