Why you may not need an MRI for your low back pain or sciatica.
Often times we look to MRI scans and CT scans to help determine an appropriate diagnosis for someone that is suffering from low back pain or sciatica. Doctors will throw out terms such as “degenerative disc disease”, “stenosis”, “bulging disc”, “herniated disc”, or one of those crazy words like “spondylolisthesis”. But the question remains do these fancy medical terms tell you everything that is going on with your back pain? Do they help you find an appropriate treatment so that you can move pain-free and return to an active lifestyle?
Recent research has shown that these scans may not be helpful at all in understanding your pain. It is likely that they do not assist you in getting the proper treatment. This study published in 2015 in the American Journal of Neuroradiology demonstrated that these degenerative changes are more normal than you think, and are often seen in people WITHOUT pain. Studies have also found that MRI scans are not helpful when determining if stenosis is the cause of low back pain. I will list some of these shocking statistics about the findings on your MRI/CT scan and discuss how this may not correlate with your low back pain or sciatica.
Here are the results you get when you put a person WITHOUT back pain through an MRI or CT scan:
27% of 20 yr olds have disc degeneration but have no pain
80% of 60 yr olds have disc degeneration but have no pain
96% of 80 yr olds have disc degeneration but have no pain
Results of the scans done on people with disc bulge showed:
30% of 20 yr olds have a bulging disc but have no pain
60% of 50 yr olds have a bulging disc but have no pain
80% of 80 yr olds have a bulging disc but have no pain
So what does this tell us?
As we see, the number of people with disc degeneration and disc bulges rises as we age but the key finding is that these people DO NOT HAVE PAIN. This demonstrates that disc degeneration and disc bulges are a normal process of aging and should not always be seen as the cause of your sciatica or low back pain. Also, the link between an MRI picture and the severity of symptoms remains controversial with studies indicating a high number of disc herniations ranging from 20%-76% in people without back pain. Just as aging on the outside (grey hair, wrinkles) is a normal process, so is aging on the inside.
There may be some underlying negative effects of getting that MRI/CT Scan as well:
People may become less active once they are given a label such as “disc degeneration” or “bulging disc” for their back pain. This inactivity can feed into negative thoughts about the health of their spine and decreased mobility as they age. It can also trap people in the vicious cycle of seeing doctor after doctor and getting scan after scan in order to determine what is wrong with them causing them even more frustration! This can all be avoided by understanding the limitations of the diagnoses that MRIs and CT scans provide.
The results of your scan may also lead to unnecessary interventions including pain medications, injections, or even surgeries. Would it make sense to get surgery just based off a picture of your back? Now in some cases, scans are necessary, but this includes a small portion of the back pain and sciatica sufferer population. On occasions, scans are necessary to rule out any fractures, tumors, or serious conditions such as cauda equina syndrome.
Let’s also consider the cost of MRIs and CT scans and how they may not even be useful. Does it make sense to undergo a procedure that will cost between $500-$2,000, which won’t even with certainty be able to determine how you will get rid of your pain? Healthcare costs are rising, meaning consumers will have to pay more out of pocket. This is something to consider when you are told you need an MRI.
What should you do?
Some questions you should be asking your Doctor if he/she recommends you get an MRI or CT scan include: “ If I get the scan how will it help me feel better” or “If I undergo this test and it shows “X” result are you confident that it actually will aid in my recovery?” The fact of the matter is long wait periods for Doctors and general diagnoses of what “may” be causing your back pain or sciatica just doesn’t cut it, and it certainly won’t help you move pain-free and remain active.
A good physical therapist will be able to treat you without an MRI because you are a PERSON and not a PICTURE. They will be able to determine the cause of your pain and treat you based on your individual presentation of symptoms. A good therapist will be able to LISTEN to you and perform a comprehensive physical exam in order to determine what treatment is right for YOU. If you are an active person with back pain and want to move pain-free without medications, injections or surgery check out my Free Report “7 Simple Steps to Naturally End Your Back Pain (and Stiffness) ”
Dr. Nick Scotto is a leading and trusted physical therapist in Jacksonville, Fl. He founded River City Physical Therapy to better serve the active adults in Jacksonville who want to remain fit, healthy, and happy. Many fitness enthusiasts, runners, and active adults have consulted with Nick looking for a permanent solution to their pain. Through education and specific treatment plans he helps them to heal their body naturally and achieve their goals of returning to the activities they love.