Do I need an MRI for lower back pain? True or False

Do I need an MRI for lower back pain is a common question that is asked when a patient has a first episode of pain or a reoccurrence of lower back pain. Most people believe when they have severe pain that immediate MRI or even an x-ray is the key to understanding the problem. It is looked upon as the essential component to start treatment. Let’s first understand what an MRI is and specifically when we are talking about lower back pain or pain in and around the lumbar region. Anyone who specializes in treating people with lower back pain realizes a proper diagnosis and treatment are comprised of three basic elements.

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First, a thorough Medical history from the patient which includes when it started, help begin with the trauma or gradually, have you received treatment before, is the pain constant or intermittent, and other medical conditions that the patient has been diagnosed. Second, during a clinical exam which includes checking the patient’s range of motion, strength, sensation, deep tendon reflexes, gait, and functional movements. Lastly, physical therapists or a doctor decides if further testing is necessary, which can include an imaging such as an MRI, x-ray, nerve conduction testing and blood work. As a physical therapist the history of the problem is often the most critical piece of the puzzle. A tremendous amount of valuable information is contained in the history. Also like the patient, is their body better than anyone to best possible treatment solutions. A famous quote is “Just listen to your patient, he is telling you the diagnosis”.

What is an MRI?

Magnetic resonance imaging is a noninvasive diagnostic tool that uses radio waves and a magnetic field to produce detailed images of the inside of a body. Doctors can use them to examine a person’s lower spine, or lumbar region, and the surrounding tissues. It can detect inflammation, disc bulges and disc herniations, thickening of ligaments, arthritis, and pinched nerve, loss of water content, degenerative changes, tumor and prep for surgery or an injection.

Is it safe?

The good news the MRI is generally safe in most cases but each patient must be properly screened for the following: metal implants, pregnancy, and allergic reactions in the past to certain dyes used in MRI imaging. As compared to CAT Scans and X-rays the MRI scan does not utilize radiation as part of the testing.

When do you decide if an MRI is necessary before you start physical therapy?

Whether it is to a doctor or physical therapist. If the patient mentions any “red flags” which come up when speaking to the patient during the history portion of the evaluation the patient is then directed to get blood work, EMG, x-rays or MRI before physical therapy can start. The following is a short list of red flags:
Low Back Pain starting at the same time as developing a fever, Severe Night pain that does not vary with time of day or position, Bowel and Bladder Changes that coincided with the development of low back pain, Severe progressive weakness in the lower extremities, Balance Problems
If you experience any of these changes an MRI may be ordered and/or a referral to a specialist. If none these red flags are present you than can proceed with care. If an MRI is ordered without the previous red flags it is non-essential for a few reasons. First and foremost many back problems resolve without any form of care in 2-3 months no matter how severe the episode may be. Also, it has been noted when people receive an MRI in the first few weeks most times the findings show many abnormalities that may have been present prior to this episode of pain. Unfortunately, MRIs show a variety of changes in your lumbar spine that are simple part of aging but may not be the “pain generators” for your recent episode. Worst of all the findings the MRI reports make patients more fearful about causing further harm and they often take longer to recover because of avoiding various forms of movement. My general recommendations is too slowly increase your activities and an working through mild lower back pain that resolves with a few hours is nothing to avoid and should allow your body to heal more rapidly. An expectation of being completely pain free as you return to activities will result in deconditioning and more time away from things you enjoy.

Additional studies have shown there is not an increased risk if an MRI is not performed initially by a physician or a physical therapist that are trained to screen for red flags. Both physical therapists and physicians can detect a need to refer out if concerned about a serious medical condition.

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