Do I Need an MRI? Understanding Imaging for Pain and Injury
You twisted your knee playing tennis this weekend—now what? It hurt when you did it, but you didn't feel a pop or snap, and you can still walk. You've rested for a few days thinking that it will just get better on its own, but it still hurts. Now you're wondering if you should've gone straight to urgent care after it happened, and if you should call your primary care doctor now. You think to yourself: What if I tore my ACL? Could I have broken something? Did I sprain my knee? Do I need an x-ray for my knee? Do I need an MRI? Is waiting to do something making my knee pain worse?
These are all valid thoughts! But what if I told you seeing a physical therapist could answer a lot of these questions and save you a lot of time? In many states, New Hampshire included, you don’t need a referral to see a physical therapist. Because physical therapists are now required to have a doctorate degree, they have the training and knowledge for direct care. A physical therapist can refer you to the proper speciality if there is something other than a musculoskeletal issue going on, and based on an assessment, can get in touch with your primary care doctor to get an x ray ordered, or get you in to see an orthopedic specialist if further care is warranted. This can save you a lot of time when you are dealing with an injury.
But let’s dive deeper into the question at hand… Do you need an MRI?
What Is an MRI and What Does It Show?
An MRI is a type of imaging that produces a three dimensional image of the body part captured. An MRI is best a showing soft tissue including the brain, spinal cord, nerves, muscles, discs, cartilage, ligaments, and tendons.
Typically an X-ray is performed first if there was a traumatic injury to rule out any fractures that would need to be addressed first. An MRI is much more expensive so if the injury can be treated conservatively, that is the best first step, because imaging does not change the conservative approach.
An MRI may be necessary if symptoms aren’t improving with conservative treatment and further treatment is being considered such as injections or surgery. If the injury is traumatic and is likely to need surgery, then the surgeon gets an MRI to visualize structures to create a surgical plan.
When an MRI Might Be Helpful
An MRI can be helpful when red flag symptoms are present. Red flags can include severe trauma, nerve damage causing weakness, signs of infection, suspected tumors. Typically with musculoskeletal injuries there is not a severe threat to your health, so they are not the first line of diagnosis like they would be for brain injuries or cancer.
If pain becomes chronic and/or worsens despite conservative treatment such as physical therapy, then an MRI may be helpful in determining other avenues of treatment to better understand if there is still tissue damage that needs surgical intervention. I always explain to my clients that unless they are ready to take a non-conservative approach such as injections or surgery, that an MRI will not change our course of physical therapy treatment, because I guide treatment based on symptoms, range of motion, and strength.
When You Probably Don’t Need an MRI (Yet)
Many musculoskeletal injuries resolve with movement-based care like physical therapy!
A study done in 2013 found that only 44% of MRI requests for the low back were considered appropriate. Meaning that the MRI likely did not dictate any change in conservative treatment plan. This shows how overused MRIs can be.
Some MRIs even show abnormalities that have nothing to do with a patient’s symptoms. This can be harmful in the sense that the patient may become worried about the findings despite having no symptoms and affect their confidence in continuing with their activity and hobbies like hiking, golfing, or running. I like to follow the philosophy of, if its not broke, don’t fix it. We don’t need to worry about normal aging processes like arthritis and degeneration, especially if we aren’t experiencing symptoms!
What to Do First Instead
Do your research and find a good physical therapist in your area! The physical therapist will perform an extensive movement analysis and evaluate your symptoms to understand the root cause of your symptoms. They will do this by watching you move, performing a neurologic screen to rule out any neurologic conditions, muscle strength testing, range of motion assessment, and other tests indicated. Based on that assessment they will create a treatment plan to address things like weakness, decreased flexibility, range of motion, nerve tension, muscle knots, and coordination.
Work with your physical therapist to create a realistic timeline for your goals, and monitor progress. If you are not seeing expected results then your physical therapist will discuss when imaging may be helpful for your recovery.
You Know Your Body Best
Always advocate for yourself if something isn’t right. But remember, your body is resilient! The body is amazing at healing itself with the right care and treatment. Movement can be the best medicine. Trust your body and your care team.
How to Work With Me
If you are local to the Lakes Region of New Hampshire and would like to work with me, book a free discovery call!
Disclaimer: The information provided on this blog is intended for general wellness education purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physical therapist, physician, or other qualified health provider with any questions you may have regarding a medical condition.
References:
National Institute of Biomedical Imaging and Bioengineering. (n.d.). Magnetic resonance imaging (MRI). U.S. Department of Health and Human Services. https://www.nibib.nih.gov/science-education/science-topics/magnetic-resonance-imaging-mri
Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2013). Overtreating chronic back pain: Time to back off? JAMA Internal Medicine, 173(11), 988–990. https://doi.org/10.1001/jamainternmed.2013.8992