Do you need an MRI? There are a lot of misconceptions surrounding back pain and the need for MRIs! Through research studies over the last 10-15 years, we have learned that many ‘findings’ on MRIs are not abnormal at all, and not actually related to how much pain someone has, or how well they are going to do over the long term. Unfortunately, family physicians and even surgeons have been slow to catch up to this new evidence, leading people to go for unnecessary scans and even unnecessary surgery! A lumbar MRI, if you don’t know how to properly interpret it, can actually have the opposite of a placebo effect, and make your back pain worse! Others will limit themselves out of fear of ‘damaging’ their back after seeing an MRI and avoid certain activities to ‘stay safe’ but this can actually make your back pain worse over time too. There are definitely situations where an MRI is warranted, not everyone gets better with conservative treatment, and some MRI findings that show issues beyond normal age-related change DO matter—but the vast majority of people with chronic low back pain need not worry about an MRI or what their MRI findings say. It is important that the findings on an MRI correlate with what we see on our physical examination— otherwise, these findings may be leading you astray from the actual cause of your symptoms.
The Canadian Association of Radiologists advise that lumbar spine MRIs are only indicated if there are “red flag” indications:
- If there is clinical concern about an epidural abscess or hematoma which may present with acute pain but no neurological symptoms, urgent imaging is required.
Other red flags include:
• Suspected cancer
• Suspected infection.
• Cauda equina syndrome
• Severe/progressive neurologic deficit
• Suspected compression fracture
- In patients with a suspected uncomplicated herniated disc or spinal stenosis imaging is only indicated after an unsuccessful 4- 6 week trial of conservative management. The College of Family Physicians of Canada also suggests only doing a lumbar MRI if ‘red flags’ are present. Our own doctors aren’t always up to date with their own guidelines!
Back pain that won’t go away? Find an exercise-based physio here with a good knowledge of the science, and let’s get you back to moving -- book in online here and see me in-person in Calgary for physiotherapy or online if you live anywhere in Alberta.