Chances are, you’ve had low back pain before. You know how debilitating it can be. When it strikes, one of the first thoughts that go through your head is “is this normal?” The severity of the pain tells you it can’t be normal to feel this way. Thoughts begin to spin through your head – “What did I do to myself? Did I tear something? Do I have a bulging disc? Do I need to get an MRI to find out what’s wrong with me?”
My answer: NO.
Let me explain…
Although it’s not “normal” to have severe pain in your low back, it is common – very common.
Low back pain affects up to two-thirds of adults at some point in their lifetime in industrialized countries1. You’re not alone. Hopefully that gives you some peace of mind, but you still want to know what’s wrong, don’t you? You want the MRI. Knowing exactly what is causing your pain would give you true peace of mind, wouldn’t it…?
Not so fast.
A recent systematic review2 of 33 articles looked at MRI findings of 3110 asymptomatic individuals – people without pain. The results show that degenerative changes in the lumbar spine are commonly seen in MRI findings of pain-free individuals as well as those with low back pain. Specific MRI findings in pain-free individuals showed:
- Disc degeneration in 37% of 20-year-olds and 96% of 80-year-olds
- Disc bulge in 30% of 20-year-olds and 84% of 80-year-olds
- Disc protrusion in 29% of 20-year-olds and 43% of 80-year-olds
- Annular fissures in 19% of 20-year-olds and 29% of 80-year-olds
Again, these are MRI findings in people WITHOUT PAIN – disc degeneration, disc bulges, disc protrusions, and annular fissures (tears in the discs).
What do these findings tell us? Is the result shown on the MRI report actually the impairment that is causing your current pain? Was it there before your pain began? It’s impossible to know for sure.
An MRI is likely to show degenerative changes whether you have pain or not. Therefore the MRI leaves you no better off than you were before – still in pain and still not knowing why.
Even if you do get an MRI, then what? Surgery? Unless it’s an emergency, surgery is always the last option in my book, especially when it comes to the spine.
An MRI For Low Back Pain Can Increase Your Fear
Another reason you shouldn’t have an MRI for low back pain is that it can cause you to dwell on the findings and catastrophize the pain.
Imagine you have moderate low back pain, you get an MRI and the report says there is a tear.
“A tear?! That sounds awful! Do I need surgery?”
Every time you experience low back pain in the future, your mind will always go back to the ‘tear’ in your back. But, in radiology reports, the term ‘tear’ often refers to degeneration and often benign conditions related to the aging process3.
The mind is a powerful thing. If given harmful information, it will spin it to create a worst-case scenario for you and your back, potentially leading to poorer outcomes.
An Open Request To Radiologists Everywhere
As we’ve seen, words are powerful. Why not put a disclaimer on every MRI report for low back pain? Like this:
This photo was taken by Matthew Currier. The comment was proposed and written by McCullough, et. al.4
This comment gives people a fair understanding of the situation. The majority of people in the US do not understand medical jargon and would benefit from a comment on an imaging report such as this.
A Better Option For Low Back Pain: Physical Therapy
If you have low back pain, my recommendation would be to forego the MRI and see a Physical Therapist first. A Physical Therapist will perform an evaluation to determine what functional impairments you have that may be contributing to your low back pain. She can also give you treatment, likely including exercises to start performing immediately to address your specific impairments.
Whether you’re currently experiencing low back pain, you’ve had low back pain in the past, or you’re incredibly lucky, there are steps you can take today to prevent low back pain in your future. For information regarding prevention of low back pain, please see How To Prevent Low Back Pain: 3 Physical Therapy Tips.
In Case Of Emergency
I am not a surgeon. I don’t order MRIs for patients. I am merely stating my opinion that it won’t benefit you to have an MRI for low back pain… unless…
There are instances where low back pain can be an emergency:
- If you have sudden bowel/bladder incontinence or worsening weakness in the legs. These symptoms could indicate nerve damage or cauda equina syndrome.
- If you have severe, continuous abdominal and back pain, which could mean an abdominal aortic aneurysm.
If you are experiencing either of these sets of symptoms, go to the emergency room immediately.
Yes, in case of an emergency, an MRI can be helpful, of course.
When else should you have an MRI for low back pain?
In my opinion, an MRI may be appropriate once all other conservative forms of treatment have failed after an appropriate amount of time. In this case, continued moderate-to-severe low back pain might warrant a closer look to see if something is potentially structurally causing your pain.
How much time? I would say >6 months. This amount of time allows acute and sub-acute phases of normal tissue healing to take place. After the 3-month mark, it is now considered chronic pain (please take a look at a previous article explaining how chronic pain works).
If it were me, at the 3-month point I would request to see a Physical Therapist who specializes in chronic pain. If 3 months of specialized treatment for chronic pain and pain management again fails, then I would potentially go for the MRI.
When I say treatment “failed”, I mean the pain is still un-manageable and you are unable to find relief. I am assuming you gave therapy 100% of your effort and were compliant with your home exercise program.
In order for you to find success with Physical Therapy, there must be a complete and total buy-in on your part, meaning you are committed to the process day in and day out.
An MRI may seem like a routine process to undergo for someone with low back pain – and in today’s healthcare system, it is. This is a problem. As I’ve explained, a lumbar MRI shows degenerative changes in people with or without pain. An MRI can also cause fear and pain catastrophizing.
Too many people are relying on opioids and surgery to relieve pain in this country. People want answers and they want a quick fix regardless of the consequences. I propose a better alternative. Physical Therapy is a non-invasive approach to treatment of low back pain with proven, evidence-based, lasting results.
Get Physical Therapy first!
Question: What are your thoughts? You can leave a comment by clicking here.
- Jarvik JG, Deyo RA. “Diagnostic evaluation of low back pain withemphasis on imaging.” Ann Intern Med 2002;137:586–97 ↩
- Brinjikji, et. al. “Systematic Literature Review of Imaging Features of SpinalDegeneration in Asymptomatic Populations.” AJNR Am J Neuroradiolv 2015; 1-6 ↩
- Bossen, et al. “Does Rewording MRI Reports Improve Patient Understandingand Emotional Response to a Clinical Report?” Clinical Orthopaedics and Related Research. Volume 471, Number 11, November 2013 ↩
- McCullough, Brendan J. et al. “Lumbar MR Imaging and Reporting Epidemiology: Do Epidemiologic Data in Reports Affect Clinical Management?” Radiology 262.3 (2012): 941–946. PMC. Web. 13 Jan. 2017. ↩︎