Here’s a great article written by Kevin Smith, SPT, and it’s a story we hear almost every day in clinic. This is more than likely exactly what you have been through a few times, and is usually something that is eye opening for your patients to hear.
It’s human nature to want to find a problem and “have it fixed.” This is especially true when we are in pain. When we get injured or have pain, a little seed is planted in our brains. We become obsessed with finding the solution to the problem. That’s where the MRI comes in. It shows us a clear image of what’s going on so we can fix it.
Or does it?
Have you ever told your patients that in many cases there is very little association between an MRI picture and a diagnosis? that these pictures can lead to treating things that don’t necessarily address the true cause of pain? that going down this path can result in hours or even years of frustration and sunk medical costs, often without ever getting the results you’re looking for?
There are plenty of people with abnormal looking x-rays and MRIs who are in no pain whatsoever.
It’s true. Take back pain for example:
This graph is based on a 2015 study looking at MRI & CT imaging of the backs of 3,110 healthy, pain-free people.
In the imaging that was studied, almost 70% of people in their 40s and WITHOUT back pain showed degenerative disc disease.
As we would expect, the numbers increase in older populations, but amazingly even people in their 20s have a 30% chance of showing degenerative findings on imaging. These are all people walking around, bending, picking things up, playing sports or performing fitness activities without any symptoms whatsoever.
It’s Not Just Backs
We see similar findings in the some of the most commonly injured and painful areas of the body.
- Shoulder– A 2014 study showed equal rates of partial and full thickness rotator cuff tears on MRI between older adults with no shoulder pain and those with current or previous shoulder pain.
- Hip – In a 2018 study, MRI revealed abnormalities in 73% of hips, including labral tears, cartilage defects, bony changes, and fractures among other conditions. All of these findings were in people without hip pain.In other words, 33 out of 45 volunteers with no history of hip pain, symptoms, injury or surgery showed abnormal MRIs.
- Knee – In MRIs of the knees of pain-free collegiate basketball players, 62% showed meniscus abnormalities, 90% showed patellar tendinopathy, and 86% showed bone marrow changes. In the general population, up to 85% of adults without knee pain show knee arthritis on x-ray.
So why is this important for patient to understand?
MRI only gives us a small piece of the pie. It doesn’t give us the whole picture!
Some health professionals want to prescribe meds or an injection or surgery, or take other steps to address an issue, based on an MRI alone. But your body is not a car. Sometimes we can’t simply replace parts; we just aren’t that simple. We are more of an ecosystem with lots of moving parts, and things are constantly changing and in flux.
Gone are the old days of patients going to see a doctor, ordering an MRI and then basing all treatment on that MRI. At least we wish they were gone! But most patients accept this as a routine procedure and the image results become the basis for every medical decision going forward.
This is where we as a profession should enter the picture.
As we can see, there are people without pain who have “abnormal” MRIs and there are also going to be people with normal looking images who have serious symptoms. We need to take the whole person into account and spend time really looking at everything, not just ONE picture.
Don’t get me wrong; there is a time and a place for advanced imaging and medical intervention. It can save people’s lives. But the fact is, the people who need surgery or something beyond conservative care are in the minority.
Getting patients back to doing what they want to do and getting them out of pain is so much more like a puzzle – with multiple clues and historical stories to uncover – and it usually takes more digging into the root issues than the info we get from an image.
There is nothing wrong with surgery for people who truly need it, but let’s work as a profession to help the patients who don’t need it avoid it.
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