Do I Need An MRI?

Do I need an MRI?

The title says it all.  I frequently hear the question.  I am frequently asked this question and it makes me cringe ever time i hear it coming.  The amount of overuse that MRI machines get in the orthopedic sector of our health care system is disturbing.  I get it.  I get why you want one.  These big, mammoth, multi-million dollar machines literally cut us into tiny little slices to show us everything inside our body.  It’s AWESOME.

It’s also expensive.  Really expensive.  Like averages $2,600 expensive (1).  I don't know about you, but I can think of a lot of things that i would rather spend $2,600 on.  This cost doesn't even include the follow up visit to review the results with your physician.

Now lets forget the cost for a minute, because hey, “insurance will cover it anyway ,right?!” (italics used to identify heavy sarcasm).  Lets get back to the question at hand.  Do you need an MRI? Probably not.  Don't get me wrong, there are absolutely times when MRI is completely necessary.  But more often than not, it’s not really needed and here’s a few reasons why.

  1. Your Doc is just as good: Research and clinical observation has given us so much information on differential diagnosis that your Physical Therapist or Physician can more than likely already tell you what that MRI is going to show.  Whether it’s your low back pain, neck pain, knee pain, shoulder pain, or whatever else pain, we can more often than not tell you what you need to know.
  2. Disturbing research: That MRI may not tell you what you think it’s telling you.  Stay with me here because this can be both confusing and hard to believe.  An MRI does not necessarily show why you’re experiencing pain.  We often associate pain with some sort of anatomical abnormality but this is not always the issue.  For example, you have back pain with pain radiating in your leg.  You go to get an MRI and Bingo! there it is on the report, a bulging disc.  Ok well guess what? That bulging disc isn't necessarily what’s causing your pain.  I know, I’m crazy.  Do you know how many people are walking around every day with bulging discs in their back?  No? Good because neither do I.  However, I do know that it’s a lot.  I’m willing to be it’s more than you think.  Depending on your age, it’s probably close to 50% (2).  That means if you grabbed any random 50 year-old off the street who has NO history of back pain, there’s a 50/50 chance that he has at least one disc bulge in his back.  If were talking about disc degeneration (DDD), the numbers are even higher!  So, maybe this back or neck pain you are suffering from isn't due to that bulging disc.  The same goes for your torn meniscus in your knee, or the torn labrum in your shoulder.
  3. Unfortunately it’s not uncommon for someone to bring in their MRI results and tell me how it found all these terrible things.  Or a young patient will come in and say “My doctor says I have the back of an 80 year old!”  WHAT?!  I immediately go into recovery mode to try to save this patient from years of pain.  The fear that these people are going to have both, consciously and subconsciously, from hearing these negative remarks is a very strong thing and can cause many issues.  These patients stop doing things they love like golfing, exercising, and hiking.  Some are scared to bend down and pick up a pencil!  They become guarded and apprehensive.  Fear plays a HUGE role in pain, especially chronic pain.  This is not my personal opinion, this is scientifically proven.

Something to consider about these facts. Let’s say you get an MRI and it shows arthritis and/or disc degeneration. You go to PT and they are able to eliminate your pain.  What do you think happens to all that nasty, terrible, scary stuff that your MRI showed?  NOTHING.  It’s still there.  All of it.  There is no way to reverse degenerative processes.  If I ever come up with a way I will let you know ASAP but I’ll be notifying you while sitting on one of the many mountains of cash I would have.  I see this more often than you can imagine.  A patient shows up with and MRI result showing Degenerative Disc Disease or a spondylosis (arthritis in the back) and a patient scared and feeling like their body is “broken” in a way.  A few weeks later, they are pain free despite nothing changing anatomically in their back.  Take a moment for that point to set in for a minute.  If you aren't sure you believe it talk to someone who as been through it before.

Here are some questions to consider when deciding for yourself whether you TRULY need an MRI. This is the same process I take with my patients when asked whether or not they need one.

  1. First and foremost, ask yourself,  What is the point of this MRI?  Or, what will I do with the information?  If you get that MRI and it shows a bulging disc, or a torn meniscus, or a torn labrum, are you going to have surgery to repair it?  If you are like most and want to do everything you can to avoid surgery, then what’s the point?  Confirming the derangement is one of the ONLY reasons I would say you would need MRI if you do plan on having surgery, and this is only because most insurances and physicians won’t do the surgery without one. This is how confident I am in the differential diagnosis ability of your Physician and Physical Therapist.
  2. How much effort have you put into eliminating your pain, and how long have you given it to go away?  People often jump right into asking about having an MRI but more often than not, there’s no reason to rush into getting one.  In our society we are able to get just about anything we want with the snap of our finger.  It’s awesome. Unfortunately though, our bodies don't really care how fast Amazon Prime is and they take time to heal.  Getting an MRI isn’t going to change that and isn’t going to make you heal faster.
  3. Is it worth the money?  As I’ve stated before, in some cases it is absolutely worth it and is necessary.  But take a moment to think about it.  As I said before, the average cost is over $2,600.  Think of the other routes you can explore to relieve your pain with that money prior to spending it on a picture of your guts.

 

Although this blog has been very anti-MRI, here are some reasons you SHOULD get an MRI. If your pain is accompanied by symptoms such as loss of appetite, weight loss, fever, chills, shakes, or severe pain when at rest you should absolutely inform your Physician or Physical Therapist so they can take the appropriate action.  It’s important for you to know that these are not the only reasons you would need an MRI.  Please do not hesitate to discuss your concerns or questions with your treating medical professional.

 

1:  http://time.com/money/2995166/why-does-mri-cost-so-much/

2:  http://www.ncbi.nlm.nih.gov/pubmed/8208267

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