MRI and Low Back Pain, Is It Necessary?


As a Physical Therapist who specializes in spine care, I see a lot of patients with back pain. For some, this is their first experience. Others, however, have had back pain off and on for as long as they can remember. Some have had surgery many years ago while others are considering a surgical option for the first time. One common thread among all of them, however, is a focus on advanced imaging such as magnetic resonance imaging (MRI) or computerized tomography (CT). By the time most patients get to my clinic they have either already had some sort of advanced imaging, are scheduled to receive an imaging scan, or are wondering if they need to get one.

I can understand why everyone is so focused on his or her metal tube selfie (MRI). Often times my patients describe their back pain as though it feels their spine is literally being crushed. You get an MRI and it shows the disc space between the vertebrae in your lower back is less than what the radiologist would expect so you get a diagnosis of degenerative disc disease. Your belief that your spine is being crushed is now confirmed with a sophisticated picture of the inside of your body. Or is it? What if I told you there is very little evidence to support you or your doctor theory that the wearing of your disc spaces directly correlates to your current low back pain…#mindblown. Let me share with you something that I try to teach patients every day in my clinic.

The background for this idea stems from various published papers in multiple medical journals over the past 10-15 years. One in particular was published in a prestigious journal by a group of researchers in April 2015. Their article was entitled “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations”. In this article they combined the findings of 3110 asymptomatic (without back pain) patients who had undergone CT or MRI’s of their lower back. The conclusion of their article was “Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.” To put that bluntly, things like herniated discs, bulging discs, degenerative disc disease, facet hypertrophy, spinal stenosis, etc, etc are merely the grey hairs and wrinkles of our spine. The fact is that, the very moment we are born, we start to age. Sorry! But at least you start out your life cute as a button. Unfortunately, our spine doesn’t look as fit/healthy on imaging when we are 50 as it did when we were 20, but neither does our outward appearance. Just the same as my face doesn’t hurt when I get a new wrinkle, neither does my spine.

Sometimes I like to play a little game with patients to help illustrate this point further. Look at the table below; find your age, and then look how common (prevalence) various age-related changes (i.e. grey hairs and wrinkles) are in people who report NO back pain.mri-tableSo, let’s say you are 40 years old and you played football last weekend. You overdid it and now you are paying the price, lying on your floor with intense back pain. You went to see your doctor who ordered an MRI because he thinks your pain is more severe than just a muscle strain and you must have done some sort of damage to your back. As per the radiologist report, your MRI shows degenerative disc disease (DDD) and a disc bulge. According to this research, 68% of people in your age category WITHOUT back pain also have DDD. 50% of people in your age category WITHOUT back pain also have a disc bulge. The bottom line is this: much more often than not, there is absolutely no correlation between the grey hairs and wrinkles of your spine and your back pain.

Why does this even matter? Because if you decide to spend your hard earned healthcare dollars on procedures (injections, surgery, etc) with the hope it will fix a wrinkle of your spine you will likely be sorely disappointed in the long term (years later) outcome, and you will probably end up in Physical Therapy at some point because the relief from that procedure did not last. Only now you will be poorer, out of shape, frustrated, and confused about why the procedure didn’t work.

When you have an episode of back pain do yourself a favor and skip the specialist with advanced imaging and opt to save money, opt for quicker recovery, #opt4pt.

neely-darrenptBlog post provided by Darren Neeley DPT, OCS, FAAOMPT, CSCS.

Darren is a Physical Therapist at Intermountain Medical Center Physical Therapy. He treats all orthopedic conditions but specializes in back pain, neck pain, headaches, and chronic pain. To schedule an appointment with Darren please call 801-507-2050. More information about conditions he treats can be found here.