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.
I hate to break it to you, but that MRI shouldn’t dictate or influence ONE BIT how your physical therapists 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 health care provider fail to educate those on their findings, we’re failing our patients. Don’t the words “degeneration” or “disc buldge” 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.”