YOU ARE NOT YOUR MRI
The advent of advanced imaging has done wonders for modern medicine. We are now able to take a detailed look inside of the body and see a huge variety of medical conditions, including fractures, tumors, spinal cord compression, arterial dysfunction, basically if you can name it, we can see it.
However, this technological marvel has some little-known side effects in the world of physical rehabilitation. This is mainly due to the fact that many of those scary-sounding issues are seen just as often in pain-free people as they are in people who have pain! This phenomenon has been heavily researched, but is not well known to some healthcare professionals, and certainly not well known among the typical person.
To back up this wild sounding idea, here are some statistics and findings from several high-quality scientific studies:
§ A study by Jensen et al in 1994 took MRI images of the low backs of 98 subjects who had NO pain. 52% of these subjects had a disc bulge at at least one level, 27% had disc protrusions, and 1% had a disc extrusion! In fact, only 36% of those pain-free subjects had “normal discs” at all lumbar spine levels
§ A study by Pappas et al in 2016 took MRI images of knees of 24 collegiate level athletes, who again had NO pain at the time of imaging. Every single knee of these 24 subjects had at least 1 structural issue on imaging. 83% of the females and 90% of the males had patellar tendinopathy, 50% of the females and 62% of the males had meniscus abnormalities, and 71% of the females and 81% of the males had cartilage defects
§ A study by Sher et al 2010 looked at MRI findings in the shoulders of 96 subjects who had NO shoulder pain. They found 14 full-thickness rotator cuff tears and 19 partial-thickness tears. They also found that the incidence of these findings increased with the age of the subjects
We could go on and on with other examples of studies that find the same conclusions, but the above-mentioned studies should drive the point home well enough. Issues such as rotator cuff tears, meniscus tears, arthritis, disc bulges, stenosis etc. are seen just as frequently in people without pain as they are in people with pain. Because of this, if you are in pain and seek out an MRI or x ray, you are more than likely going to find something “abnormal,” whether or not it is actually contributing to your pain! These studies actually state that due to the high prevalence of these findings in people without pain, MRI/imaging results MUST be taken in context with a thorough clinical examination, as they frequently have false positives.
Because of this, people often get these scary sounding labels, have increased fear about what is going on, and end up spending more money (because MRIs are expensive)! In fact, several studies have shown that people who get early MRIs spend more money and do worse than people who see a Physical Therapist for their pain!
All in all, as miraculous as advanced imaging is, all it provides us with is a picture. What is seen on the picture might not even be related to your pain, and the image doesn’t give us any information about other very important things such as how you move, your activity level, and physical and mental stressors. All these factors play a hand in your pain. So, if you are experiencing pain, it is recommended to avoid jumping the gun and getting imaging, and to seek out a qualified Physical Therapist instead.