Should I have an MRI scan to help diagnose my lower back pain?

In the majority of cases of low back pain, MRI scans, and especially x-rays, are not helpful in achieving the ultimate goal of helping back pain sufferers to recover. After all, this is the very reason for seeking treatment and going for scans in the first place.

The general comment that I hear from patients is: “if I can just get a scan done then I can figure out what is wrong and get it fixed.” However, in reality, a scan shows a lot of structures with varying degrees of abnormalities that are present both in those with and without back pain.


Science becoming more aware of risks of MRI scans

Healthcare practitioners such as physiotherapists and chiropractors are becoming more aware of this; however, convincing a client that they do not need a scan can prove challenging. I know from having injuries myself that you are naturally curious and there is a part of you that wants to see the area and identify ‘what is wrong’, even if the research suggests it is not beneficial. Worryingly, more recent findings in the literature have identified negative effects of having back scans. Research shows that those who undergo MRI scans can actually end up with more back pain. This is because after the MRI is performed a report of the findings will be written up by the radiographer. The report will often contain findings of areas where there is bony growth or discs bulging to varying degrees. The problem is that because such findings are present for most people, they can be deemed normal; however, the fact that they have been written onto a medical report suggests to the patient that they are abnormal and therefore serious issues that are the cause of that person’s symptoms.

Are MRI findings really abnormal?

Unlike other medical reports which primarily focus on abnormal findings; MRI scans can report deviations from the ideal spine that can be deemed normal or abnormal. These deviations are relative to the ideal spine of a young person with perfect spinal curves. Most people going for MRI scans are not in this age bracket and therefore the findings are normal for that age group. This fact underlies a lot of the confusion resulting from MRI reports.

Questions to ask when you have an MRI scan:

The main questions you should ask your physiotherapist is this:

  • Can the finding on my MRI report explain all of my symptoms?
  • If the findings from the MRI report are the sole cause of my symptoms then why do my symptoms fluctuate or disappear entirely before returning again?

The linking of symptoms to findings on MRI scans are often illogical

These elements are difficult to explain based on MRI findings alone. These ‘things’ reported on scans can create serious concern for patients. Things such as bulging discs have seriously negative connotations for patients and can create a degree of panic, even though these things may not be the cause of their symptoms at all.  This diagnosis can lead to a lack of movement and exercise which can create more back pain in the medium to long-term.

In most cases, the identification of a serious disc injury or other spinal conditions of concern is more accurately performed by a clinical assessment carried out by a Physiotherapist or Chiropractor who specialises in back pain. They can identify quite readily those relatively rare cases where patients  actually do require onward referral for an MRI scan.


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