Anyone who has ever experienced an injury or prolonged pain knows how frustrating the unknown can be. Lack of clarity about what caused the injury in the first place, where specifically the pain is originating from, and how long it will be until the symptoms go away can create anxiety and fear. This anxiety and fear is what motivates people to scour the internet for answers, and ultimately make an appointment to see a doctor or other medical professional.
Patients often believe (or are influenced by a healthcare professional to believe) that the only way to address their pain is to find out exactly what is wrong. Some are under the impression that by having an MRI or other costly imaging performed, they will be presented with a perfect diagnosis and a fool-proof treatment plan. While this is sometimes the case, more often than not the diagnostic process is a little more complicated than that.
This is not to say that MRIs are useless. MRIs can be a great tool, if for no other reason than they can provide peace of mind by ruling out a more serious injury, such as a severe muscle tear or ligament sprain. But do MRIs always provide the most useful answers? And does the steep cost of an MRI provide more value than seeing a physical therapist instead? Here are a few reasons why you should carefully consider whether getting an MRI is the appropriate next step for you.
No one’s body is perfect, and therefore neither are MRIs
“Abnormal” findings on an MRI report are actually quite normal. As we age our bodies are continuously adapting to the stresses placed upon them by work, recreational activities, and everyday tasks. In fact, multiple studies have demonstrated that a large percentage of symptomatic patients have normal MRI results, while a majority of patients with no symptoms at all present with at least one “abnormal” finding on an MRI scan. When it comes to diagnosing low back pain, MRIs can be particularly misleading. One study of 98 people with no back pain at all found that over 50% of the subjects presented with a disc herniation on their MRI report.
In many cases, MRI findings can appear more concerning than the actual symptoms being investigated in the first place. Many of the diagnoses listed on an MRI report have zero impact on the patient’s level of pain or function, yet common phrases such as “moderate degeneration” and “partial tear” can be a source of panic. This is why it’s important to have a provider on your side who can take the time to perform a careful assessment and determine what findings are actually relevant to your condition.
MRIs are only a snapshot
Research has shown that physical therapists (75% accuracy) and orthopedic surgeons (80% accuracy) can pretty closely diagnose musculoskeletal conditions compared to an MRI. While this is another example of why getting an MRI isn’t necessarily any more beneficial than seeing a qualified provider, this data does indicate that at least 20% of the time clinicians and MRI reports don’t agree on a diagnosis. As previously discussed, this doesn’t necessarily mean that the MRI is always right. That’s because MRIs (and other imaging tests) are only looking at a specific part of your body at a specific moment in time as you lay in a static position.
What these scans fail to account for are the multitude of other factors that can contribute to pain and dysfunction, such as mobility, strength, core stability, posture, movement quality, cardiovascular health, nutrition, sleep quality, and psychological and emotional stressors. Why allow a two-dimensional picture of your body to lead you down the road to injections and surgery without addressing these other aspects of your health first? All of these factors can be assessed and managed by a physical therapist, particularly one that’s able to work with you in a one-on-one, client-focused setting.
MRIs should not ultimately determine your treatment approach
Once someone receives their MRI report, the question becomes “What do I do next?” The reality is that in most cases, the results of an MRI don’t ultimately alter the course of treatment. Unless there are “red flags” discovered during an examination, they will likely participate in some amount of physical therapy along the way. Assuming that rest and oral anti-inflammatory medication have already been prescribed, there are three primary treatment options following an MRI: physical therapy, injections, or surgery.
The second option typically doesn’t address the actual cause of your pain, but merely masks the symptoms by decreasing “abnormal” inflammation found on the scan. It’s not uncommon for the pain to return in the near future because the root cause of the issue hasn’t actually been addressed. The third option is clearly the most invasive, and in some cases provides minimal or no long-term improvement in symptoms compared to more conservative approaches. These treatment methods should only be pursued after you’ve undergone a comprehensive physical therapy evaluation, and a multifaceted approach has been unsuccessful over a reasonable period of time.
Seeing a PT prior to getting an MRI may save you a lot of money
There’s also a reason that many insurance companies require an episode of physical therapy before allowing their patients to get an MRI – doing so saves them money and by extension saves you money. On average patients spend $4793 more on their healthcare costs when they get an MRI prior to participating in physical therapy. When physical therapy is tried first instead, patients spend 72% less on healthcare within the first year.
MRI results can lead to unnecessary testing, medication prescription, injections, and surgeries, not to mention time lost from work or paying for childcare to attend all of these appointments. Patients often have to wait for authorization from their insurance provider before scheduling an MRI, which can delay treatment and contribute to additional expenses, slower recovery time, and increased psychological and emotional stress. Where you live can also have an effect on how much you will end up paying for medical procedures such as MRIs. A 2016 Charlotte Observer report found that the average cost of an MRI in Charlotte, NC was almost twice as much as the national average.
“But my doctor said that I need to get an MRI”
The truth is, you should always have 100% control over what you do with your money, your time, and your health. That’s not to say that you should ignore your doctor’s advice or that an MRI is always unnecessary, but it’s important to always weigh the costs vs the benefits when it comes to any healthcare decision. At FLO Physical Therapy & Performance we can help steer you in the right direction and ensure that you’re taking the right steps to quickly get back to the lifestyle that you enjoy.
References:
Jensen MC, et al. “MRI imaging of the lumbar spine in people without back pain.” N Engl J Med 1994; 331:369-373
Moore JH, Goss DL, Baxter RE, et al. Clinical diagnostic accuracy and magnetic resonance imaging of patients referred by physical therapists, orthopaedic surgeons, and nonorthopaedic providers. J Orthop Sports Phys Ther. 2005;35(2):67-71.
Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368(18):1675-1684.
Fritz JM, Brennan GP, Hunter SJ. Physical therapy or advanced imaging as first management strategy following a new consultation for low back pain in primary care: associations with future health care utilization and charges. Health Serv Res. 2015;50(6):1927-1940
Garloch, Karen. “Health Care Costs Often Higher in Charlotte.” Charlotte Observer, 27 Apr. 2016, www.charlotteobserver.com/living/health-family/karen-garloch/article74250597.html.
