Do I need an MRI or an x-ray?
Patients often ask us if we think they need an MRI scan, and our answer is nearly always no. Let’s take back pain as an example. It is estimated that only 1-5% of back pain is caused by a serious medical condition that could be detected by an MRI (and these people usually have other symptoms as well as pain), meaning that for roughly 95% of people with back pain an MRI is a costly and unnecessary procedure. This is because most people’s pain is not caused by an underlying disease or ‘broken structures’ (1). However, MRI scans can provide a lot of reassurance, by confirming that a person’s pain doesn’t have a more sinister cause. Yet when taken out of context, the results from these scans can actually increase anxiety.
Many people who’ve had scans in the past tell us that they have “bulging discs and arthritis” and so avoid movement, often by giving up the activities they love. Yet disc bulges are very common even in people with no pain! A 2015 study showed that 29% of 20 year olds had disc bulges but no pain, and 37% of the same pain-free group also had arthritic change. By 80 years old, 48% of people had disc bulges with no pain (2).
These findings challenge the assumption that pain is due to age or “wear and tear”, and they show once again why scans are not always helpful. MRI scans can’t show pain, and we have had very healthy patients with what look like ‘awful’ scan results, as well as patients who experience a lot of pain with ‘perfect’ results. Pain is far more complex than we previously thought, and is not simply the result of damage or ageing, hence why MRI scans are often not the answer to diagnosing your pain.
But it’s not just our backs that are affected. In 2006 the Royal College of Surgeons found that even in people with no shoulder pain, 11% had full-thickness rotator cuff tears and 38% had some degree of damage (3). These people would never have known that there was anything ‘wrong’ if they hadn’t had a scan, and the ‘damage’ these scans picked up were having no bearing whatsoever on their quality of life. Yet being told you have a full-thickness rotator cuff tear in your shoulder could cause a level of anxiety that would start to negatively impact your life, as fear and anxiety have been shown to increase pain.
Even athletes with peak physical fitness show ‘worrying’ MRI findings despite being pain free: 89% of young athletes had hip problems according to their MRI results (4), and an entire basketball team had knee problems (5), yet these are young people living active, pain-free lives.
The take-home message from this research is that some element of structural damage is a normal part of life (a bit like getting grey hair) and is not well linked to pain or function. Just because a scan has shown a problem doesn’t mean that it is causing pain, and nor should you avoid moving an area for fear of damage. Lack of movement in fact increases pain, and leads to the loss of strength and flexibility. Our bodies are strong and resilient and generally respond well to exercise and movement. If you try worrying less and moving more then you may be pleasantly surprised by just how much a difference this can make to both your quality of life and any pain you may be experiencing.
Do you want to know what is causing your pain and if we can help? Why not take advantage of our new patient assessment introductory offer to get you started towards a tailor made recovery plan for only £19.
Are you in a lot of pain and want to get better as soon as possible? If so then why not book in for a new patient consultation, with treatment on the day, for £65.
We are also there to help you from home. Take a look at our suite of exercise resources and advice sheets which you can easily download and use from home.
1 – Magee, D. Zachazewski, J. and Quillen, W., 2009. Pathology and Intervention in Musculoskeletal Rehabilitation, Missouri, Elselvier.
2 – W. Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes and J.G. Jarvik. (2015) American Journal of Neuroradiology, 36 (4) 811-816; DOI: https://doi.org/10.3174/ajnr.A4173
3 – Reilly, P., Macleod, I., Macfarlane, R., Windley, J., & Emery, R. (2006). Dead Men and Radiologists Don’t Lie: A Review of Cadaveric and Radiological Studies of Rotator Cuff Tear Prevalence. Annals of The Royal College of Surgeons of England, 88(2), 116–121. http://doi.org/10.1308/003588406X94968
4 – Briggs K, Philippon M, Ho C, et al. (2017) Prevalence Of Acetabular Labral Tears In Asymptomatic Young Athletes, Br J Sports Med;51:303.
5 – Pappas, George P. MD, PhD; Vogelsong, Melissa A. MD; Staroswiecki, Ernesto PhD; Gold, Garry E. MD; Safran, Marc R. MD, (2016). Magnetic Resonance Imaging of Asymptomatic Knees in Collegiate Basketball Players: The Effect of One Season of Play. Clinical Journal of Sport Medicine: November 2016 – Volume 26 – Issue 6 – p 483–489