8 out of 10 people will experience low back pain in their lifetime. That is the vast majority of us! I have already checked this box thanks to a water skiing injury a few years ago. Although not a fun experience, it was helpful for me as a physical therapist to be “on the other side” of the system for a change. I found myself wondering many of the same things my clients ask me. Will this just go away in a day or two? Am I going to have to deal with this for years? Do I need an x-ray or MRI? Do I need to go see someone or can I manage this myself? Should I take an anti-inflammatory? What about ice or heat? The list goes on.
If your first stop is urgent care, often an x-ray is recommended to confirm you haven’t fractured anything. This makes sense to rule out one source of acute pain. Often from there you are referred to a specialized physician who may recommend an MRI before proceeding with other treatment. Unfortunately, by the time you have checked all of these boxes, it can be days or weeks before you get to a physical therapist.
A few reasons you may need an MRI include:
-Progressive loss of sensation in your extremities
-Progressive weakness in your extremities
-Changes in bowel/bladder function
-Changes in balance/tripping over your feet
What is NOT on that list? Acute pain isolated to your lower back. That doesn’t mean you aren’t in a LOT of pain…it just means that likely getting an MRI will not change your course of care at that time. You may be wondering why.
Did you know?
That MRI’s of asymptomatic individuals show:
37% of 20 year olds
80% of 50 year olds
96% of 80 year olds
…Have disc degeneration, aka degenerative disc disease
30% of 20 year olds
60% of 50 year olds
84% of 80 year olds
…Have disc bulging, aka herniated discs
To phrase this in a different way, 80% of 50 year olds without any back pain show signs of disc degeneration. 60% of 50 year olds without any back pain have disc bulges. So it turns out, some of these “abnormal signs” may not be so abnormal. They are just like wrinkles in the spine…many of us have them, and they’re a normal part of the aging process. So unfortunately, looking at a person’s MRI really doesn’t tell us definitively how they feel or their level of symptoms.
Again, this is not to say there is NEVER a time for an MRI. They can be essential in specific scenarios where an injury has started to affect the nervous system. But I think it is really important to share this information so you know that your image does not define you or how you feel. There is so much not shown on an image that impacts your level of pain or lack thereof.
And a lot of those things are in your control:
-Core control and strength
-Hip and upper back flexibility
-Hip and upper back strength
-Amount of sleep
-Emotional stress
The list goes on!
So in summary, understand that an image isn’t always a necessary part of your treatment plan. Physical therapists are trained to evaluate you to determine whether or not you do need an image to determine the best course of care. And if you do get an image, or already had an image, also understand this is only one piece of the puzzle. Many people have findings on an MRI but are not experiencing any low back pain. With the right care, we can all be one of those people!
Reference:Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. W. Brinjikji, P.H. Leutmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A., Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes, J.G. Jarvik. American Journal of Neuroradiology Apr 2015, 36(4): 811-816. http://www.ajnr.org/content/36/4/811
