An MRI Does Not Tell Us How to Treat Your Back Pain so Why Do We Need It?

​Whether or not to have an MRI is a discussion I have at least once every week.  The reason I talk about it is because the decision to do an MRI should not be one that we arrive at without an understanding of what is to be gained and lost.

Let’s identify some of the takeaways from doing an MRI for your back pain.

The MRI can often help us determine where your problem is.  We can also get a picture of the structures involved, but it will usually not tell us if you are a surgical candidate or not; that is determined by the surgeon based on his/her physical exam of the patient.  Though the MRI may show us a picture of what is going on, it still does not tell us which structures are causing the pain. 

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The MRI rarely helps guide the physical therapist’s treatment.  We are, or at least should be, in the business of treating the person, not treating the MRI. I will change the PT treatment based on symptom response and patient feedback not because the MRI told me to do this or that.   There are certainly times when information can be gleaned from the MRI that gives a PT some further clarity on the issue, but it is certainly not the determinant of what treatments we are going to use or not use.

Believe it or not the MRI can change back pain…sometimes for the better and sometimes for the worse.  Lets investigate how that happens.

The test can make your back pain better.  How you ask?  Because once you see that there is nothing serious requiring surgery your pain system may calm down.  Your pain system is made up of your brain, spinal cord, and nerves.  All pain is modulated by the brain so if it calms down then your pain may as well. This obviously does not work for everyone but there are many cases where people get better from just having the MRI read positively in their favor.

Improvement with the MRI is not the rule, it is typically the exception.  What happens more often is that people get worse once the MRI report comes back.  This is because there are many large and scary terms in the report that most people think are going to lead to a lifetime of pain and dysfunction.  Once the average person hits 30 years old there will inevitably be something that can be found on a spinal MRI that could be a source of pain.  If we started doing MRI’s on healthy, pain free spines we would find these same scary terms, such as disc degeneration, disc bulging, spurs and narrowing that we found on the patient’s MRI with actual pain. But because MRI’s cost money it is silly to do them on people who have no complaints.  If we did, it might be helpful to show patients with pain that a scary MRI does not equal a life of pain and suffering.

The take home message from this blog post is this:  I am not vilifying the MRI test, but before you get one for your back pain you must understand that it is not the key to all your problems and it will most likely not tell anyone what to do to make your pain go away.   The answer to making your pain go away lies in your response to treatment and having someone that will listen to your problems and help you find ways to solve those problems.

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John Oxley PT,
​DPT, OCS, CSCS, Cert. MDT​