Should I Have an MRI for My Low Back Pain?

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by Mike Napierala, PT, SCS, CSCS, FAFS

According to a list recently compiled by the North American Spine Society:

The NUMBER ONE thing spine patients and physicians should question is having an MRI during the first 6 weeks of back pain. 

Research shows that it is most often unnecessary and will not make your back pain go away more quickly.  It is important if you have back pain to understand why you may or may not need an MRI.

An MRI can create an image showing certain structures in your back such as bones, discs, and nerves. The physician reviewing the MRI may see things like changes in a disc or joints often described as a bulge or degeneration or narrowing.

The problem is, while you may be able to see a variety of age-related or activity-related changes, it does not necessarily mean your pain is coming from that tissue. Many people have these sorts of changes happening in their spine but have no pain. These may be changes that have happened over time, not necessarily on the day your pain started.

If you have tight muscles, difficulty moving, weakness, or muscle spasm, you may not be able to diagnose them by looking at a standard MRI. If your symptoms are severe enough to warrant surgery or a spinal injection, your physician may order an MRI to more specifically evaluate the condition of your spine to prepare for surgical intervention.

There are some conditions or circumstances where an early MRI may be justified including history of cancer, unexplained weakness, loss of bowel or bladder control, or other neurological symptoms. If you are experiencing any of these symptoms you should contact your physician immediately and they will decide which tests are most appropriate.

Otherwise, findings on an MRI will not necessarily change your course of care or treatment for your condition. A physical exam in the office including such things as movement testing to determine what provokes or relieves your symptoms, postural assessment, and biomechanical screening for underlying causes usually tell us more about what treatments will work best for you than an MRI can.

Your treatment should be individualized based on the above exam findings, and your unique history and goals.

If you have back pain and your physician does not recommend an MRI immediately, remember that an MRI is a test that will most likely not change your treatment or hasten your recovery. Try to follow the advice that your health care team gives you to get back to pain-free living as quickly as possible!

References:

1.  North American Spine Society. Choosing wisely: five things physicians and patients should question. 9 October, 2013. web: 4 September, 2014. http://www.choosingwisely.org/doctor-patient-lists/north-american-spine-society/

2. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.