Patients sometimes will arrive to their first physiotherapy consultation holding their MRI results, and the moment they sit down, they point to the report and say: “Ok, so I’m here because of two lumbar herniated disks. Just look at the report.”
Although MRI is an advanced medical imaging technique that can form anatomical pictures to a high degree of precision, how predictive are the results to your current injury? Moreover, how likely is it that what you see in the report is the actual cause of your current pain?
From our experience, more often than not, the MRI results do not correlate with the severity of injury, and in fact instead contribute to negative perceptions, fear, and avoidance behaviours.
We’ll give you an example:
A patient of ours was suffering from some local low back pain so she underwent an MRI. The results showed two disk protrusions and some ‘disk degeneration’. She quickly associated the disk protrusions and herniated disks as the cause of her pain and worried extensively about her ‘worn out disks’. She also knew an uncle who suffered from herniated disks and he ended up stopping all his sports activities and ended up in a wheelchair. This further raised her apprehension and since she did not want to ‘wear out’ her disks more, she stopped her horseback riding and exercising. When I saw her, she had already avoided most physical activities for over two years.
Upon evaluation, there were no clinical signs of herniated disks. What in fact impaired her the most was the excessive de-conditioning and fear subsequent to the two years of avoiding all activities. Although it took over six months of rehabilitation, of re-strengthening, correcting her false perceptions of how fragile her spine was, re-introducing activities back into her life, and convincing her how important these activities are to her spinal health, she was able to fully return to both her sports and horseback riding with no pain.
MRI results & current pain
Do not immediately assume MRI results to be the cause of your current pains. These results need to be taken into account with your clinical findings.
To further illustrate this message, observe the infograph created by @Leedarrenh:
Research evidence demonstrates that if we grabbed 100 individuals off the street who have no back pain, and did an MRI on each of them, 37% of them would have findings of disk degeneration. This finding would sky rocket to 96% if your age is 80 or over. What this means is that you will find ‘abnormalities’ on MRI in most asymptomatic individuals.
Furthermore, research evidence (Chou et al., 2009) has shown that imaging does not improve a patient’s clinical outcome.
Trust your Physiotherapist
When presented with your MRI findings, do not fall into the vicious cycle of self-diagnosing your injury and assigning a cause. Your MRI results are but one piece of the assessment tools your physical therapist would use to evaluate your overall condition. By undergoing a thorough evaluation, your physiotherapist will determine the origin of your injury based off of your clinical findings, radiographic findings, your pain presentation, your injury history, your movement patterns, and any present dysfunctions.
Let CAMPT-Certified Physiotherapists help you get back to the best version of yourself.
About Nan Wu
Nan is the co-founder of Integral Performance Physio. Following the completion of her Master of Science in Physical Therapy at McGill University in 2011, Nan developed a wide array of clinical experience, from sports-related injuries (e.g. ankle sprains, concussion, ACL tear), work-related injuries (e.g. overuse and postural syndrome), post-surgical cases, to chronic complex illness (e.g. fibromyalgia, Joint Hypermobility Syndrome). In 2017, she obtained her second Master’s degree in Master of Clinical Science from Western University and proudly became a fellow of the Canadian Academy of Manipulative Physiotherapy (FCAMPT). Follow Nan on Instagram and Facebook and check out her Website.