MRI scan for low back pain?

a Mallorca Physiotherapy blog article

About as useful as the ‘g’ in lasagne…

I’ve been having a lot of discussions lately with patients who ask me if I think they should have an MRI scan “to really see what’s going on in there”. These patients are coming to see me because they have low back pain.

The MRI scan is an amazing invention and can be invaluable in diagnosing a whole host of things. It is not, however, to be used for any old ache or pain, or just “to have a little look inside”.

The majority of the population will have some degree of low back pain at some point in their life. Fact. If it impacts on your daily life, you may seek help to either manage or resolve it.

That’s where we as Physiotherapists often come in to try to save the day…

Following an assessment which includes both a physical examination and LOTS of questions about your life in general, we can come up with a plan of action.

This will inevitably involve participation in some physical activity, I mean you, by the way!

Exercise is generally the way forward so this will be tailored to your individual needs and you will be supported as much as you need, but ultimately it’s you that has to do it!

Patience is a virtue… so they say!

Many patients will ask me “How long until I feel better?” or “How long before I notice a difference?” and it’s always so difficult to answer! It completely depends on the condition we are dealing with, it completely depends on the patient’s compliance with treatment/exercise, it completely depends on that particular human…

Some patients have more patience. Those who don’t will often start to wonder about alternatives or question the plan we’ve come up with. And that’s perfectly reasonable, after all it’s them that has to deal with it on a daily basis.

But it’s at this point I have to give it my best ‘car salesman chat’ to persuade them to stick with it and that “no, an MRI scan probably won’t help at all”.

Pretty amazing isn’t it! To actually see what our spine looks like is quite fascinating and brings our anatomy to life. But, what do we do with this information now we have it? That’s my point.

There have been numerous studies (and if you want references I’ll happily send them to you) that show a pretty poor correlation between MRI findings and patient’s actual presentation.

Basically, many people with no back pain whatsoever have been found to have bulging discs, bony growths, some narrowing of joint spaces, etc on MRI scan but they are happily going about their daily business completely oblivious to all this!

Conversely, patients with back pain have been found to have quite minor visible changes on their MRI scan, but they’re suffering. So where does that leave us?

At the end of the day, an MRI scan is only useful if it is going to change our plan of action.

Just because we find out that the disc between your fifth lumbar vertebrae and your sacrum is a bit squashed doesn’t mean I’ll have to give your exercise program a complete overhaul.

Not to blow my own trumpet, but I’ve probably already guessed that was the case from the assessment we did at the very beginning and your answers to my many questions…

So, unless something in your history or in the way your pain is behaving is concerning me, I would be reluctant to advise or recommend an MRI scan for your low back pain. Let’s focus on the physical activities and get on with getting stronger, because that is a far more positive step towards a more comfortable existence.

Lauren Rigg

Mallorca Physiotherapy

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