Your MRI isn’t magical. It’s just a picture. You’re a dynamic complex system that has an amazing ability to adapt. A picture doesn’t tell the whole picture of why or where you are experiencing pain.
Everyday in my clinic I get someone who is sold on the idea that their MRI describes their exact pain.
The problem is when you’ve come to me, you’ve had all the standard treatments – physical therapy, NSAIDs, cortisone injections, epidurals, nerve blocks, ablations, even failed surgery.
All of these treatments are done based solely on the MRI. When I ask, most of these doctors never performed a thorough clinical exam to correlate the MRI findings with the patients pain.
If we take a step back and do a good exam, more often than not, pain doesn’t match what the MRI shows.
Your MRI isn’t as important as you were sold.
Most pain just creeps up over time – in these cases MRI is generally useless.
If you took an MRI of 100 people over the ago of 40 with no back pain, about 60 will have herniations, bulges, arthritis and stenosis even though they have NO pain.
That means it’s normal to have these degenerative changes as we get older. It doesn’t mean they are the cause of pain. Maybe they’re a piece of the puzzle – but we can’t connect those dots without a good physical exam.
So let’s explore a better approach
#1. In the absence of progressive neurologic deficits or other red flags, there is strong evidence to AVOID CT/MRI imaging in patients with non-specific low back pain.
Studies have shown that patients with no back pain often show anatomic abnormalities on imaging.
Unnecessary imaging is expensive and leads to unnecessary procedures.
The better option is to mind a manual medicine provider to perform a good hands on exam and who can help educate you in the best steps for your specific situation. I do this in my clinic in Tampa, FL every single day.
#2. Avoid NSAIDs & cortisone injections.
Both of these are given out like candy but they have terrible long term outcomes. We become reliant on NSAIDS (advil, aleve) and they never fix anything. Cortisone injections cause long term denegation and lead to instability and arthritis in and around the structures that were injected.
Our body has this amazing ability to heal under the right conditions. Regenerative treatments like acupuncture, dry needling, prolotherapy and PRP injections have robust evidence and excellent clinical effects. Try them before you go down the slipperly slope of NSAIDs, cortisone shots, and surgery.
#3. Avoid surgery at all costs if there was no clear trauma.
It’s crazy but orthopedic surgeries like discectomies and meniscus surgeries have terrible long term outcomes. The evidence is clear that often times their effect is no better than physical therapy alone.
Find a provider who can use specific regenerative interventions like I mentioned above and find a good physical therapist. The combo of these two tools is safer and in the end more effective for the vast majority of pain conditions you will experience.