Patients often ask me if they can get an MRI of their lower back? While this is not always a bad idea, there is a lot that goes into those decisions.
First and foremost, it isn?t going to harm anything: It won?t hurt you (it won?t make your back pain worse unless lying still on your back for 30 minutes is painful), it won?t hurt them (the MRI companies are good with it), so then why not get one? Good question. We?ll get back to that?
A few days ago, I was talking with a patient in one of our clinics and he was asking for an MRI of his neck. Why, I asked. Because his insurance covers it and he wants to find out what is really wrong with him. Therein lies the problem.
Don?t get me wrong, MRIs are great. They have really advanced the ability to diagnose and treat our patients and we are much better off in medicine because we have them. We can see ACL and rotator cuff tears, tumors, disc herniations, et al.
But, they are not the be-all and end-all. They can give us a great diagnosis after an acute injury like a sports injury or an injury resulting from a car accident. However, many clinicians and doctors rely on MRIs to assist with diagnosing and treating a patient with a chronic problem like repeated episodes of low back, neck, shoulder, or knee pain. That is exactly the wrong approach and the reason is that we don?t KNOW that the changes or ?problems? we see on the MRI is the thing causing your pain.
Before there were MRIs there were CT Scans. Before there were CT Scans there were X-rays. And before X-rays we used our brains?and our hands.
Doctors desperately need to get back to using these tools and only using the imaging to help confirm our diagnosis. Not only will this help you have a better outcome because you would get a proper diagnosis, but research shows us that you will also be less likely to have surgery, less likely to need pain medication, and less likely to have injections. In fact, specifically for chronic lower back pain (CLBP), there was a systematic review published in 2011 by Chou1, et al that concluded:
Although there may be an association between degenerative MRI changes and CLBP, it is unknown if these estimates accurately represent the association given the quality of included studies, lack of a direct link between degenerative MRI changes and CLBP, and heterogeneity across studies. Thus, a strong recommendation against the routine use of MRI for CLBP evaluation is made. Since there are no data evaluating the efficacy of the surgical treatment of degenerative MRI changes, a strong recommendation is made against the surgical treatment of CLBP based solely upon degenerative MRI changes.
Basically, even though there are degenerative changes like disc herniations on MRIs in people with lower back pain, they STRONGLY recommend that patients should not get MRIs or have surgery for it including those who have repeated episodes of lower back pain over a period of time.
But, there is also another reason, something a bit more altruistic, but seriously important. Unless you have been living under a rock for the past few years, you know that healthcare costs are skyrocketing. The costs to us as the consumer or patient have gone up, those include deductibles and co-pays; and premiums have increased at a pace that far exceeds inflation. But, the costs to the insurance company have also increased due to a lot of unnecessary testing and exams. And, when you have a lot of unnecessary exams performed, insurances need to pass those costs along to someone, so they pass them along to us, the consumer, the patient.
1Chou D, et al. Spine. 2011 Oct 1;36(21 Suppl):S43-53.
Whatever your thoughts on the state of our healthcare system and what needs to be done to fix it, there is one thing on which most of us agree, and that is we need to control costs. Getting a good exam from a good doctor and getting an MRI or other expensive imaging study, only when the good doctor feels it can benefit your care, is the right approach. Call me old school, but believe me, medicine, and health care in general, is heading back to its roots. Join me, why don?t you?
Dr. Barton Bishop, PT, DPT
Dr. Bishop is a physical therapist and the Chief Clinical Officer at Sport and Spine Rehab. He may be contacted at BBishop@ssrehab.com
Sport and Spine Rehab companies provides chiropractic, physical therapy, and rehab services at seven locations in the Maryland and Virginia suburbs of Washington, D.C. and Baltimore. Services include Graston Technique, Kinesio Taping Method, and Funhab? which is Sport and Spine Rehab?s own trademarked research-based functional rehab protocols.