Do you know when it is appropriate to get an MRI or diagnostic imaging?

The Limitations of MRI Results

When it comes to diagnosing certain medical conditions, MRI (magnetic resonance imaging) is often considered a reliable tool. However, it's important to understand that MRI results have their limitations. While an MRI can provide detailed images of the internal structures of the body, it may not always provide a definitive diagnosis. Pain is complex and doesn't always paint a clear picture. In fact, Barreto et al found that after imaging 123 participants with one-sided shoulder pain, patients had similar findings on both sides. Multiple studies can be cited showing cases where patients have positive findings on imaging with no pain and people with severe pain have clear MRIs. 

What does this tell us? 

You are more than your image. The findings from imaging will be taken into consideration of course but so many other factors play a role in your prognosis. What is your pain level, mobility, strength of this area, activity level, or goal that you want to get back to? And this is only part of your story. 

Signs and Symptoms that May Indicate the Need for an MRI

Now that we know you don't need an MRI to address your pain, let's discuss some instances where MRIs are warranted. 

1. You are run over by a bus

kidding....kinda, but 

2. There has been a traumatic event with associated swelling and debilitating pain, which would likely first warrant an x-ray

3. Progressive neurologic symptoms with associated muscle weakness and changes in bowel/bladder

4. You have tried conservative treatment.

Conservative treatment includes a well-structured rehab plan tailored to your specific needs and goals. Conservative treatment is NOT a steroid injection, rest, and massage, despite what you've been told.  

Factors to Consider before Undergoing an MRI

With this, sometimes imaging is needed and indicated. Before undergoing an MRI, there are several factors that need to be considered. These include:

1. Cost 

Imaging can be expensive depending on your insurance and how much of your deductible you have met. Be sure to know your benefits prior to agreeing to imaging. 

2. Implications of findings

If you do have positive findings on your imaging, then what is your plan? Often when an MRI shows a tear anywhere, surgery is indicated pending size and location. Some people "need to know" what is wrong, which is understandable, but you need to be prepared to have the conversation of surgery if this is the case. Yes, MRIs without surgery are possible but be able to advocate for yourself and ask all of the questions. 

The Role of Physical Therapy

Physical Therapists are Doctors who are trained to diagnose, evaluate, and treat musculoskeletal conditions, often without imaging or steroid injections. This is because we are treating the person as a whole, as discussed earlier in the blog, rather than masking an underlying problem or issue. 

If you have been dealing with a problem for more than a few months, then you likely have mobility and strength limitations associated with your problem. Therefore, if you undergo surgery to fix a tear that has been lingering for months or even years, then you will need to do extensive rehab afterwards to address these limitations so your problem doesn't come back. 

Patients who opted for Physical Therapy first over injections, MRIs, and surgery saved on average between 18-54% over the course of their treatment. This is averaging between $1-3,000 for PT compared to close to $5K on average for injections and $17k for surgery (without post-op PT). 

As a provider, MRIs can be helpful information but not necessarily needed to treat the condition. This is because I'm treating the person and not the problem. I'm not treating a torn meniscus. I'm helping you manage your pain and function so you can return to running, lifting, and hiking with your family. 

Save yourself time and money, go to PT first.