Is an X-Ray or MRI appropriate for the pain you're experiencing?

“Should I get an X-ray or MRI before coming to see you?”

This is a common question I get from clients coming in for their first visit. Often these clients are experiencing unexplained and/or long-standing pain and it seems logical that imaging would provide an image of what specific tissue(s) are irritated or causing pain.

A 2020 study on imaging of the spine “found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients.” (Corso et. al 2020)

This reinforces something that I try to teach to everyone who comes in through my door, “the tissue is not always the issue”. Meaning that an isolated irritated tendon, muscle, body part, etc. is painful but it may not be the culprit/cause behind your symptoms. Can it be a contributor? Yes. But typically, angry tissue (shy of anything catastrophic) is the victim. The victim of other areas working poorly resulting in an overload of the tissues, movements and/or positions in question.

This is why imaging can become an impractical step in resolving the sources of your pain/injury.

Issues with imaging

X-rays and MRI can be an unreliable indicator of injury. There are a lot of studies out there that have shown up to 30% of asymptomatic people showed a disc bulge on an MRI but never experienced any back pain. Disc bulges are common, normal changes in the spine that accompany aging.

Once a doctor labels age-related changes as “arthritis”, “wear and tear” or “bone on bone” and imprints these images of catastrophic damage in the mind of their patient, they are more likely to attribute their symptoms to that label and actively avoid things like lifting weights, running, stretching, etc. that may reduce/remove their pain.

Other studies have been done with patients who have shoulder pain and volunteered to have both shoulders imaged. What was found? The healthy shoulder had the same prevalence of abnormalities as the painful shoulder, some of these abnormalities included: partial tears, arthritis, bursitis. Similar results have been observed in patients with knee pain.

Another point for consideration is that clients with debilitating pain have had imaging come back 100% normal.

The results of your imaging are not likely to change or influence your individual treatment plan. There tends to be a belief that imaging will heal the problem because you’ve identified an “answer” to the pain and you know exactly which tissue is angry. This does not change my course of action for resolving the problem. My initial goal is to get you out of pain and then begin chipping away at the contributing factors.

Imaging can give “false positives”. Imaging can present findings that aren’t true to the source of the pain/symptoms. Studies have shown that if 100 asymptomatic people over the age of 25 were given an MRI of their low back, the vast majority would have some news coming back from the radiologist.

Let’s be clear, imaging has its place.

If there is an acute injury or if, following an initial visit, the PT sees imaging as appropriate then it should be utilized. However, many times over, a thorough assessment performed by a PT, resistance training and movement coaching can resolve the problem without the assistance of imaging.

Imaging can be expensive, it can provoke fear or misplaced beliefs as to the status of the tissue and highly unlikely to influence the course of treatment.

So what are you some alternatives to imaging that can get you out of pain or help you recover from an injury?

1. Take the imaging money and spend it on a gym membership or sessions with a PT.

2. Consistent training & performance of your PT homework.

3. Consistency is key in recovering from an injury. Using your PT as a resource and listening to their instructions, sleeping better and managing stress will likely accelerate your overall recovery and mitigate future injury.

4. Find a PT you can trust. You should feel that your PT is listening to you, explaining things thoroughly and not rushing your care so they can move onto the next patient.

At Southeast PT, the goal is to see you as few times as possible and order imaging only if absolutely necessary. The expertise used in performing your assessment often surpasses the information imaging can provide. This is why we perform thorough assessments and provide clients the resources and exercises to perform on their own. We are not just treating symptoms; we’ll also take a look at your sleep, stress and nutrition to treat the system as a whole.

Our responsibility is to educate you on how to manage your current pain or injury and we believe this is possible without imaging. If you would like to set up an initial assessment please send an email to southeastphysicaltherapy@gmail.com today!