Back Pain Myths: Do I Need An MRI For Back Pain?

Debunking the Myth: Imaging Isn't Always the Answer

It's a commonly believed myth that diagnostic imaging such as X-rays and MRIs are essential for identifying and treating low back pain. In reality, we know that less than 5-10% of all low back pain is due to a specific underlying spinal pathology and the remaining symptomatic people have no serious structural cause. 

Relying too heavily on imaging for answers about why you’re having back pain can cause you to miss the mark in resolving deeper- rooted movement based issues that are actually leading to your pain. At Athletes’ Potential, our goal is to improve healthcare for the better, and we approach treatment differently from other providers you may have seen in the past. Let’s jump in!

A typical MRI or X- ray of someone with lower back pain may show disc degeneration, disc herniation or bulging, osteophytes (bone spurs), stenosis, loss of disc height (degenerative disc disease), spondylosis/spondylolisthesis, etc. Now, while some of these findings may be totally normal age- related changes (it’s normal for discs to shrink as you age), others, such as disc herniation, are indicative of structural changes.

The Limited Role of Imaging

1. Structural Damage Does NOT Equal Pain: Studies have shown that findings from MRIs and X-rays do not always correlate with the symptoms you experience. Research consistently finds that many people with no back pain at all have positive findings on an MRI – including disc degeneration and even herniations! There are also many people who have no structural changes whatsoever based on imaging results, but are in severe pain nonetheless.
2. Focusing on Function, Not Just Structure: Lower back pain is often functional, meaning it’s more about how your body moves and less about structural changes. If you’ve had back pain for a long time, there’s a good chance whatever structural changes were found initially are long healed by now! Research shows that disc herniations typically heal within 6-12 months. That means that if you’re still dealing with pain after that time, you’re likely dealing with symptoms of an underlying movement problem that likely caused the structural changes in the first place! Our approach is to assess and improve your movement patterns and pain responses, which can't be captured in an image. 
3. Avoiding Unnecessary Stress: Excessive imaging can often lead to undue stress and anxiety. Knowing you have a "bulge" or "degeneration" in your spine can create fear and a misconception that your body is fragile, which can actually impede the healing process. Research shows that imaging is often associated with prolonged recovery times as well as increased costs of treatment. 
4. Cost-Effective Care: Instead of wasting time & money on unnecessary imaging, we focus on a more cost-effective approach to treatment, ensuring that your resources are utilized in the most beneficial way – through movement therapy and interventions that directly address the underlying cause of your pain. Oftentimes, the diagnostic imaging results won’t affect how the treatment plan is progressed and therefore useless.

Athletes' Potential’s Approach to Diagnosing and Treating Lower Back Pain

• Thorough Clinical Assessment: We start with a detailed evaluation of your pain, movement, strength, flexibility, and goals. This all-inclusive approach provides more relevant information about your back pain than an image could, and serves as a starting point to your health and wellness journey
• Personalized Treatment Plans: Based on our assessment, we design a treatment plan tailored specifically to your needs. This plan addresses the root causes of your pain through targeted exercises, manual therapy, and lifestyle modifications. 
• Focus on Education and Empowerment: Understanding the nature of your pain and how the body works is a powerful tool in your recovery. It is one thing to get you out of pain, but we teach and provide the tools necessary to stay healthy years down the road so the problem doesn’t come back. 
• Regular Monitoring and Adaptation: We closely monitor your progress and adapt the treatment plan as needed. This dynamic approach ensures that you are always moving forward in your recovery journey. Life happens, and we know this! Adapting the plan based on your progress will help you stay consistent throughout the entire plan of care.

When is Imaging Necessary?

It's important to note that some people will benefit from imaging to help guide treatment, especially if there is suspicion of an underlying condition that may be impeding progress. Examples of “red flag” conditions we rule out with low back patients are spinal cord involvement, infections, tumors, and fractures. The good news is that we are more than qualified to identify these cases, and can provide next steps to receive imaging if we deem it beneficial to your overall health. Typically, patients we see do not need to go this route.

Your Path to Recovery - Two Approaches to Back Pain Relief

Let’s say you have back pain and can choose between two options: 

Option A: You decide to get a diagnostic image of your back. The doctor sees on the image that you have arthritis, degenerative disc disease, and decreased lumbar curvature of the spine. To help with the pain, they prescribe strong anti-inflammatory pills to take the edge off. You feel okay for the first one to two  years, slowly increasing the dosage overtime. But, three years later the pain returns because the main source was never addressed, and the underlying problem got worse.  You go back to your doctor and they refer you to a spine surgeon to discuss more invasive options. This scenario is a slippery slope, and although pain pills can be a great short-term fix, they do not solve the problem. 

Option B: Your friend tells you that they got rid of their chronic low back pain after a few months of physical therapy and recommends their local therapist. You give it a try. Although it took more effort than popping a pain pill, you start seeing results within the first week. After four to five weeks you are relatively pain-free. Regardless, you continue working with your therapist for a few more sessions.  You learn the correct way to move and how to take care of your body while fixing the main cause of the issue.  Better yet, three years down the road you are armed with the knowledge and skills to never have to deal with this injury again and aren’t forced to rely on medications or book an appointment with a spine surgeon. 

To clear the air, opting to get lower back imaging does not guarantee a downward spiral of your health. But, settling for a short term fix while avoiding the root cause of a problem is a mistake that many people fall victim to in the current healthcare model. Empower your journey to a pain-free life by understanding your body and collaborating with dedicated professionals committed to your recovery.

Take Action Today

Ready to take the first step towards a pain-free life? Book a free 15-minute phone consultation with a member of our team to discuss your concerns, learn more about our approach, and decide how we can best help you on your path to recovery.

Call us now at 470-355-2106 or click here to schedule your free consultation and start your journey back to a pain-free, active life.

Stay strong, 

Dr. Dom

References: 

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8805092/