It is very common for people who suffer from pain to seek help from their primary care physician first, as opposed to a physical therapist (discussed in “Physical vs. Opioids” article). This ultimately leads to more imaging tests being performed (x-ray, MRI), which further leads to increased healthcare costs, but is this effective in determining the symptoms causing the pain?
What is an MRI?
MRI stands for magnetic resonance imaging and is commonly used identify soft tissue structures, such as muscles and ligaments at high resolutions and have a high diagnostic accuracy for determining structural abnormalities. An x-ray on the other hand is commonly used to see bony structures.
What does it mean if my MRI shows something isn’t normal?
Most human beings will not have perfect MRI findings, especially as we get older and our bodies have been put through more physical abuse. BUT this does not mean that we have pain and it does not mean that what it shows is causing us pain, as I will discuss below:
- 123 people aged between 18-77 with pain in ONE shoulder lasting from 1 month to 3 years in duration, volunteered to have BOTH shoulders scanned.
- There were just as many finding seen on MRI’s in pain free shoulders as there were in painful shoulders, except for full thickness tears and glenohumeral OA. This means that 7 out of the 9 possible shoulder pathologies (injuries/abnormalities) were the same on the non-painful shoulder.
- 1 patient with chronic low back pain had 10 different MRI scans at 10 different centers
within 3 weeks.- The results of these 10 scans showed 49 different problems but NOT ONE of these finding was reported on all of the 10 scans. This high variability in findings can have a detrimental impact on the treatment of this patient.
- 206 people with knee pain and 504 people without knee pain were given MRI scans.
- They found just as much “pathology” (abnormalities) in the pain free knees as
they did in the painful knees!
- They found just as much “pathology” (abnormalities) in the pain free knees as
To conclude…
This highlights that pain is NOT only dictated by the results of our scans. This shows that whatever structural abnormalities you may have, this does not mean it is the reason for your pain or predict that you will have pain. Many things that are seen on scans in those with pain are also seen in those without pain! In the presence of serious diseases and abnormalities MRI’s and other imaging tests are invaluable to making quick and accurate diagnosis, HOWEVER without these serious signs MRI’s can lead to misdiagnosis for your pain and over diagnosis.
If pain is interfering or holding your back from performing the activities you love, reach out to a performance physical therapist!
References:
Barreto, Rodrigo Py Gonçalves, et al. “Bilateral Magnetic Resonance Imaging Findings in Individuals with Unilateral
Shoulder Pain.” Journal of Shoulder and Elbow Surgery, 2019, doi:10.1016/j.jse.2019.04.001.
Guermazi, A., et al. “Prevalence of Abnormalities in Knees Detected by MRI in Adults without Knee Osteoarthritis:
Population Based Observational Study (Framingham Osteoarthritis Study).” Bmj, vol. 345, no. aug29 1, 2012,
doi:10.1136/bmj.e5339.
Herzog, Richard, et al. “Variability in Diagnostic Error Rates of 10 MRI Centers Performing Lumbar Spine MRI
Examinations on the Same Patient within a 3-Week Period.” The Spine Journal, vol. 17, no. 4, 2017, pp. 554–561.,
doi:10.1016/j.spinee.2016.11.009.