Since their development in the early 1980’s, MRI scans have revolutionized diagnosis and treatment of back pain. Unlike X-Rays, which typically show the condition of the bones in the spine, MRIs also provide images of the supportive soft tissues surrounding them, like muscles, ligaments, tendons and discs. Since physicians typically have a good idea of what they’re looking for to diagnose an injury, is it really necessary to invest in this potentially costly imaging scan before having back treatments?

What is an MRI?

MRI stands for Magnetic Resonance Imaging, and these scans are typically performed in a radiology clinic or hospital setting. The MRI machine rotates a large magnet around a patient, and by exciting hydrogen atoms, they create images by capturing the slight amounts of radiation released. The scans show anatomical elements by displaying differences between tissues with a lot of water (fat, fluid, discs) and tissues without (bone, cartilage). A trained radiologist then reads the scans and creates a report on the findings.

Why MRI?

Whether or not you need an MRI scan before back pain treatment is a matter of debate, according to a report published in the Current Reviews in Musculoskeletal Medicine in 2009. When patients present with acute back pain, the typical recommendation is a wait and see approach. Doctors will do what they can to help alleviate the immediate pain, but historically, most back pain tends to resolve itself within 4-6 weeks. However, when back pain is associated with pain or other neurological symptoms like numbness and tingling that radiates into the limbs, further diagnostics are necessary. The same study reported that sciatica was present in 95% of cases where disc herniation in the low back was detected.

MRI and Back Treatment

While they can be very beneficial, it’s important to remember that MRI scans aren’t the only diagnostic sources to consider when it comes to back treatment. MRIs can show damage to structures in and around the spine even in people with no pain symptoms whatsoever, so scan results really need to correlate with the specific symptoms experienced by the patient. Guidelines published in the Annals of Internal Medicine suggest the use of MRI when cancer, infection, or nerve damage is suspected, or when pain doesn’t improve after initial treatment. Also, many non-surgical approaches like physical therapy, exercise, yoga, and spinal decompression are general and gentle enough to provide back pain relief without the need for advanced imaging.

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