Should You Get an MRI for Back Pain

Back pain and sciatica are incredibly common.

While most cases of back pain resolve with conservative treatments such as physiotherapy, exercise, and lifestyle modifications, there are instances when additional diagnostic tools are required to accurately assess the underlying cause.

Seeking treatment from Physiotherapy and Doctors, many people are looking for a solution to their back pain and can have questions regarding diagnostic testing. In particular MRI or Magnetic Resonance Imaging and will it uncover some extra information that will help them recover from their back pain.

Most back pain does not require an MRI or any other imaging tests. An MRI requires a Drs referral and they will do an evaluation to identify if an MRI of the spine may be helpful.
Input from your Physiotherapist can be very helpful with this process.

It can be frustrating for patients to be denied an MRI when they feel their pain warrants it. But it is important to understand the uses and limitations of spinal MRI scans. With the information in this BLOG you will be able to better understand the recommendations.

What Does Lumbar Magnetic Resonance Imaging Show?

MRI machines produce detailed images of your spine. It is a non-invasive imaging technique that uses powerful magnets and radio waves to create detailed images of the body's internal structures, including bone, ligament, discs, nerves, the spinal cord, muscles and other surrounding soft tissues.

The Drawbacks

Most people have lots of evidence of old injuries and degenerative changes in the MRI report. Most of these findings may have little to do with the symptoms experienced. MRI changes occur in both people with low back pain and people without pain.

It is only when the clinical examination and a finding on the MRI match, that there may be useful information.

At Hindmarsh and Fitzroy Physiotherapy, we emphasize that not every case of back pain requires an MRI. In fact, an over-reliance on imaging can sometimes lead to unnecessary interventions or treatments that may not be in the patient's best interest.

Additionally, an MRI report can be anxiety provoking by giving the impression there is much more wrong with your spine than is clinically relevant. The majority of the MRI report may simply be normal wear and tear. Researchers investigating this have found is that, when patients read their report and it says words like “compression”, “degeneration” or “arthropathy”, they can believe that their spine is in much worse health than it really is.

Can You See Nerve Damage On An MRI?

You can’t determine if a nerve is damaged by looking at a lumbar MRI scan. However, you can see if there are any soft tissues or structures compressing the nerve. When this is correlated with your clinical exam we can determine if the nerve is likely to be producing your symptoms.

Long Term Worries

Back pain and Sciatica sufferers often have concerns that their back pain may one day progress to paralysis. The overwhelming majority of people with low back pain do not need to worry about their spinal cord at all. In the very rare instances where the spinal cord is at risk there are key signs and symptoms that clinicians will look for such as:

  1. Profound motor weakness in the lower extremities
  2. Widespread sensory loss in the legs
  3. Bowel or bladder dysfunction
  4. Saddle Paresthesia ( Perineum or contact area of bicycle seat)

When may an MRI Indicated

  • The signs and symptoms above for spinal cord involvement
  • Difficulty walking or balance
  • Severe back pain in children
  • Recent significant trauma
  • Suspected fracture or cancer
  • Symptoms of infection, fever, unrelenting night pain, sweats, weightloss and serious illness
  • Unresolving significant back and LEG pain that has failed a trail of 6-8 weeks of Physiotherapy and conservative management
  • Need for Surgical intervention

Clinical Assessment First

Our approach is rooted in thorough clinical assessment. Our experienced physiotherapists are trained to perform comprehensive evaluations of patients with back pain. We consider factors such as medical history, physical examination, and response to conservative treatments before considering advanced imaging.

In many cases, targeted physiotherapy interventions, postural adjustments, exercise programs, and pain management strategies can effectively alleviate back pain without the need for an MRI.

Collaborative Decision-Making

The decision to order an MRI is never made in isolation and we believe in collaborative decision-making that involves the patient as an active participant. We discuss the pros and cons of MRI, explain its role in diagnosis and treatment planning, and address any concerns that you may have.

In Conclusion

While MRI can be a powerful diagnostic tool for assessing complex back pain cases, it is not always the first line of investigation. Our approach prioritizes evidence-based care, clinical assessment, and conservative treatments whenever possible but recognize the significance of an MRI when it is truly warranted.

The decision to order an MRI for back pain is not one to be taken lightly. At Hindmarsh and Fitzroy Physiotherapy, we believe in a thorough and evidence-based approach to determining when MRI is indicated for back pain. We work closely with our patients and their Drs to ensure that their journey to recovery is guided by the most appropriate and effective strategies.

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