Ask a PT: I have back pain that is not going away, should I get imaging?

If you have had a trauma or been in an accident, and have back pain as a result, you will want to get into a provider to have an x-ray done just to rule out a fracture.

Otherwise, if you have back pain of non-traumatic origin in the absence of other symptoms, such as intense lower extremity pain, significant and progressing weakness in one or both lower extremities, loss of bowel/bladder control, and/or loss of sensation, you are not likely to benefit from getting an MRI.  The first course of action with this type of back pain should generally be conservative care.

MRI results are not always accurate in identifying a person’s source of pain, and because of this they can be misleading and misinterpreted.  Research shows that having an MRI in some cases is not associated with significantly greater pain reduction or function after treatment.1  Additionally, an MRI is often performed to determine whether or not surgery may be indicated and there is an increasing body of research that does not support spinal surgery as a means to improve patient outcomes.MRI is often ordered inappropriately so it is important to consider this when consulting for an MRI.3

It is also good to know that excessive imaging throughout your life can increase your risk of cancer a small amount, according to the FDA, so it should be utilized only when appropriate and necessary.4

With generalized back pain in the absence of the symptoms mentioned above, the course of treatment is often conservative for at least 6 weeks, regardless of what shows up on MRI.  When this is the case, it may better for your health to avoid the MRI at first and determine if you have success with conservative treatment.  Conservative treatment can consist of a variety of options including rest, exercise, taking pain killers in the acute stages, or seeing a physical therapist, chiropractor, massage therapist, Chinese medicine specialist, etc.  Physical therapy is a good option because the therapist will be able to use a combination of manual therapy, modalities, and strengthening to address your back pain.

Back pain is very common and although there are certain cases where more serious medical pathologies should be ruled out, it is important to be educated on the appropriateness of MRI and rule out conservative treatment options before seeking more invasive options.

A good article on this that was written for the New Yorker in 2002 can be accessed here: http://www.newyorker.com/archive/2002/04/08/020408fa_FACT

If you have questions about back pain or what to do about it, you can contact us at Ascent Physical Therapy clinic in Avon at (970) 949-9966 or Eagle at (970) 328-5230.

1. Cohen S, et al. Effect of MRI on treatment results or decision making in patients with lumbosacral radiculopathy referred for epidural steroid injections. Arch Intern Med. 2012;172(2).

2. Smith J, et al.  Operative and nonoperative treatment approaches for lumbar degenerative disc disease have similar long-term clinical outcomes among patients with positive discography. World Neurosurgery. 2013.

3. Emery D, Shojania K, Forster A, Mojayerian N, Feasby T. Overuse of magnetic resonance imaging. JAMA Intern Med. 2013;173(9):823-5.

4. American Cancer Society. Available at: http://www.cancer.org/cancer/cancercauses/radiationexposureandcancer/xraysgammaraysandcancerrisk/x-rays-gamma-rays-and-cancer-risk-do-xrays-and-gamma-rays-cause-cancer. Accessed 2/5/14.

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