PT Myth Busters: MRI Edition
Updated: May 10, 2022
One of the biggest myths we see in PT is that MRI findings will fully explain a patient’s pain or physical symptoms. Or that if a patient has an MRI, we will then know exactly why the patient is having the pain that they're having. That may be true in some cases, but studies are finding a lot of “abnormal” findings in routine MRI’s of pain-free individuals. (Big shout out to our Dr. Stephanie Soto for summarizing References 1 and 3 below). Here are some examples:
A review of low back MRI scans of 3,110 pain-free individuals found the following: (Ref. 1)
· In 20-year-old’s: 37% had disc degeneration, 30% had disc bulges
· In 50-year-old’s: 80% had disc degeneration, 60% had disc bulges
· In 80-year-old’s: 96% had disc degeneration, 96% had disc bulges
A study on neck MRI scans of 1,211 pain-free individuals found the following: (Ref. 3)
· In 20-year-old’s: 77% of females had disc bulges, 74% of males had disc bulges
· In 50-year-old’s: 92% of females had disc bulges, 90% of males had disc bulges
· In 80-year-old’s: 84% of females had disc bulges, 93% of males had disc bulges
According to a 2020 study of 230 pain-free knees: (Ref. 2)
· 97% had abnormalities!
· 30% had mesniscus tears
· 62% had articular cartilage abdnormalities, of these, 41% were moderate or severe
· 52% had bone marrow edema, 27% were moderate or severe
· 46% had tendon abnormalities. 27% were moderate or severe
So what gives? Abnormal findings appear to be mostly routine, increase with age as normal age-related changes, and are signs of expected physical changes in our joints. In cases of an acute or severe injury, or in cases of patients not progressing as expected in PT with conservative care, MRIs can be helpful. But much of the time, especially if an MRI is done prematurely, the results just end up confusing the situation. Maybe that meniscus tear has been there for 10 years, and isn’t the source of your pain. Maybe you’ve had three neck or back disc bulges for a while, and none of them are a problem. I mean look at those numbers, 74-77% of 20 year-olds have disc bulges in their neck! You're actually abnormal if you have a normal MRI!
Just because you have an MRI and it shows wear and tear, arthritis, or other things, there is no cause for panic. Rest assured that in most cases, surgery isn’t warranted, and there is no need to start injections and pill popping. Most situations can be handled with Physical Therapy. The thing we want to avoid when it comes to interpreting MRI results is this example: An Ortho or someone immediately starts blaming all your symptoms on something that is there on MRI or imaging but really isn’t an issue at all, and you end up having an unnecessary surgery, or end up having an increased sensitivity and reaction to pain and feeling defeated like you're destined to have chronic pain. It happens a lot. Do you or someone you know have a history of “my back hurts, the MRI showed a disc issue, we did surgery, and the same pain was still there.” Well guess what, it wasn’t that disc issue causing your pain!
Again, I'm not going to say that MRIs and surgeries aren't warranted some of the time, because they absolutely are. I've even recommended several patients to surgery in my time based on their specific physical findings and history. What I am saying is that in most cases, MRIs and surgery aren't the answer.
Besides MRI results, it is important that your medical provider is also listening to your specific symptoms, when and under what circumstances the pain started, the type of pain you’re having (sharp, dull, deep, etc.), when your pain feels better or worse (sitting, standing, walking, etc.), and what activities (or lack thereof) you are involved in. Ideally, they should also be testing other clinical measures such as mobility and strength, to name a few. Otherwise, it is hard to say for sure if your MRI findings match your actual clinical findings, and if the MRI results have anything at all to do with the pain you’re experiencing. And if the clinical findings and MRI images don’t match, the MRI results can just basically be filed in the “good to know” section of your medical chart. Unfortunately, in today’s hustle and bustle of the medical world, medical imaging has acted as a substitute for thorough clinical evaluation and critical thinking. So, before you rush off into that surgery or Cortisone shot, make sure you talk to your Physical Therapist first! If you would like to talk to one of our Doctors of Physical Therapy for free by phone or in-person, fill out our quick request form here https://www.thegrpt.com/events-and-offers
In good health,
Dr. Ashley Bertorelli, PT and Founder/Owner of The Green Room Physical Therapy
1. Brinjikji, Luetmer, et al. 2015. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol.
2. Horga, Hirschmann, Henckel, et al. 2020. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiology.
3. Nakashima, Yukawa, et al. 2015. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine.
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