MRI Scans, Imaging and Investigations
MRI scans are a hot topic in my clinic room, especially as I mainly work with people with persistent problems. However, I very rarely refer out for them.
Let’s take a look at MRI scans, imaging and investigations. Hopefully, by the end, you will understand when are they useful, when they might cause more harm than good and that the reason you are not being sent for one is not just to save money.
New ways of thinking about MRI scans
I speak to many people who are frustrated about not being sent for an MRI scan. Frustrations because they believe it is being held from them. Some think that the only reason they are not having one is to save the NHS money. Whilst for others, it is frustration because of the mixed messages from healthcare professionals. For some, it is not frustration but worries that something is being missed.
Whilst investigations used to be a common route for diagnosing conditions. Modern research has started to show that they have limited value in many cases and can actually worsen the situation. That is not to say that there is not a place for them.
If we took low back pain as an example, it has become evident that diagnosing a structural cause is impossible in 90-95% of cases. There is no indication of a serious cause in most cases and they should be managed with conservative treatments. Treatments such as advice and reassurance, exercise, physical therapy, behaviour change, improving sleep, mindset change and nutrition.
More recent research has helped us to realise why anomalies with investigations exist. Why some people can have findings and no pain and others can have significant pain and a clear MRI scan. This is not just the case for back pain, research is emerging across all body parts. There are now many studies showing that if you scan someone over the age of 15, there is a chance you may find something.
MRI Scans and coffee tables?
MRI Scans are a bit like using a magnifying glass or a microscope on a wooden coffee table, it is likely you will find imperfections. These imperfections do not mean that the table no longer functions or needs to be discarded.
Only one part of the picture
Scans and other investigations are a small part of any individuals picture. The clinicians you see will diagnose your problem and how best to manage using your clinical history and examination. They will also screen you for signs of serious conditions, they may just not tell you they have done so.
Following the assessment and for a small group of individuals, scans and further investigation are warranted. If this is the case for you, it is very likely that your GP, physio or surgeon will have already sent you for one.
It is also worth noting that, any findings on MRI Scans are only a useful part of the picture when the findings match the clinical picture. I.e. active nerve root compression and symptoms in the corresponding area or a meniscal tear in a knee that is clicking, locking and giving way.
MRI scans are usually only necessary to rule out significant conditions or to help plan for surgery. It is also worth noting that MRI scans may also not be the best investigation for a particular condition. Sometimes, ultrasounds, x-rays and blood test are more useful.
MRI scans and imaging can do more harm than good
Research shows that imaging such as MRI scans may actually do more harm than good when serious conditions are not suspected. It is likely to prolong recovery in patients with non-specific low back pain for example.
Some individuals may think that a scan may help to reassure them; for some, this may be useful. However, we also know, that how any findings are reported back to you, can also influence your recovery. If your results aren’t explained properly, it can be worrying and lead to over-protecting the area.
In addition, unnecessary imaging also has some risks such as radiation exposure and delays to appropriate treatment. Unfortunately, for some, it can also lead to unnecessary surgeries.
Treatment and management is often the same
The treatment for most musculoskeletal issues is actually the same regardless of whether imaging is used or not. Often it is the management strategies that need to be focussed on and not the diagnosis. For many individuals, recovery can still happen, even without a diagnosis.
You may know players, coaches or other people who have had an x ray, CT, or MRI of their back/joint and it showed “changes”. That must mean something is serious…right?
This is not always the case, most of the changes seen on imaging are normal and are more common the older you get. This is the same as if we were to take a picture of your outside as you get older; changes are seen such as grey hair and wrinkles (or becoming follicly challenged…like me). As these ‘internal’ changes also occur in people without pain, their relevance is unclear. So often with or without changes, management is the same.
But I have had a setback!? Do I need a scan now?
Setback to recovery is actually really common. If you are not progressing or you have had a flare of symptoms, this doesn’t automatically mean that investigations and scans are needed. Speak to your therapist, clinician or GP. As when the issue started, they will screen for serious conditions. If you are clear of those signs and symptoms, further investigation may play no part in overcoming the setback.
Setbacks and flare-ups can be triggered by a number of internal and external factors. Factors such as:
- Changes in mood
- Stressors (other people and events)
- Poor sleep
- Changes in activity levels
- Environmental changes
- Poor nutrition
Again, looking at the whole picture around the setback/flare-up will give strategies to recovery and progression. Like at the onset of an injury or pain problem, scans are only relevant to a few individuals when a setback occurs.
Recap about MRI scans and Investigations
- There are currently no investigations that can see or diagnose pain
- We know that tissue damage and pain are not always related
- It is Common to find biomechanical ‘flaws’ on both people with and without symptoms
- Investigations are only one bit of the puzzle and can be misleading if looked at in isolation
- How the findings are discussed with the individual is vitally important
Final Note
Remember, these resources should not replace diagnosis and management from a medical professional. Always check before you follow the guidance and feel free to drop us a message if you want to discuss anything covered further,