So you just had an MRI of your lumbar spine (lower back) and you went to see the doctor for the results or tried to read the MRI results yourself. Quickly you became confused, overwhelmed, and/or anxious reading all these “bad” things about your back. What should you think of these really big, negative sounding words like degenerative, spondylosis (the fancy term for arthritis in the spine), narrowing, etc? Quick answer…….not much at all.
It is estimated that about 80% of people will experience low back pain at some point in their lives. A high percentage of this low back pain is non-specific – meaning healthcare professionals cannot pinpoint one specific structure to the cause of your pain.
This is why when you speak to 10 different healthcare professionals about your low back pain you get 10 different answers – and, yes, I understand how frustrating this is. It doesn’t mean that every one of them is wrong, just that there are differing philosophies & approaches to the cause of your pain. Just remember that many of these philosophies are formed by the healthcare professional’s treatment options and what they can actually do for you – prescribe drugs, perform surgery, help you move better, etc.
So if there isn’t one specific structure that is causing your low back pain, why does your MRI show so many things wrong with your back? Multiple studies have shown a large amount of coincidental findings on spinal MRIs (also present with other body parts too, but we’ll focus on the spine for the sake of this article).
multiple studies have found that about 40% of asymptomatic (without any pain) people have bulging disc(s)
this study did a literature review (of 33 other studies) of spinal imaging results in asymptomatic people and the following table summarizes their findings:
this study talks about the unnecessary usage of lumbar MRIs and below is some of what they mention
they estimated that about 50% of all CT scans and 33% of MRIs of the low back are not necessary.
overall, it discusses how the increased use of unnecessary imaging may actually lead to less favorable results and “…that overuse of MRI for patients with low back pain is related to an increased rate of surgical procedures that have not consistently been shown to significantly reduce painful symptoms and improve daily function.”
this study was done to identify the association between referral source (which doctor referred you to physical therapy) and discharge functional status and number of physical therapy visits. They found that, “…patients with low back pain who were referred by occupational medicine and primary care physicians tended to have better functional outcomes and required fewer physical therapy visits per episode of care.” This matters with regards to MRIs because primary care physicians are unlikely to prescribe MRIs, while specialists are more likely to have you get an MRI.
another interesting tidbit of information is that lumbar MRIs look different in the morning vs. in the evening; and when you are laying down vs. standing.
With the high prevalence of “abnormal” MRI findings, an MRI of the lumbar spine tends to put you down the route of more invasive procedures – epidural injections, surgery, further testing, etc. If you have no desire to pursue any of these invasive interventions, then there really is no need for you to get an MRI.
I do have to make this important point though – this doesn’t mean that lumbar MRIs are useless. There are some instances when an MRI of the lumbar spine is warranted and should be done promptly:
rapidly progressing neurologic symptoms (weakness and/or numbness) in leg(s)
sudden bowel/bladder dysfunction or incontinence
when a more serious non-orthopedic condition is suspected (tumor, infection, cancer, etc)
When I treat a patient for low back pain and they ask me about their MRI results, I talk with them about what is mentioned in this article (and also other modern pain science explanations) and tell them to take the MRI results with a grain of salt. I tell them that as physical therapists, we actually don’t care what the MRI says, rather we care about what you complain of, how your body moves, and what we can do to help – the MRI results don’t dictate or change our treatment plan.
After having this discussion, many of these patients (admittedly not all – some get “attached” to their results and seem to wear them like a badge of honor) have immediate reductions in anxiety about the results and some even feel better – even though I haven’t even touched them yet.
Next time you speak with a healthcare professional and they recommend you get an MRI (for anything, not just your low back), ask them why they think it is necessary and how it will affect their treatment plan for you. It could potentially save you time and money and lead to a quicker recovery.
And remember, you don’t need a prescription to see a physical therapist (read more about that here)