Author: Written By: Kevin Smith, SPT
You Are Not Your MRI
This is a story we hear every day. This is more than likely exactly what you have been through a few times, and we are going to have a big surprise for you. Something that is eye opening and a little scary.
It’s human nature to want to find a problem and “have it fixed”. This is especially true when we are in pain. When we get injured or have pain, a little seed is planted in our brains. We become obsessed with the finding the problem. That’s where the MRI comes in. It shows us a clear image of what’s going on so we can fix it? RIGHT?
OR DOES IT?
What if I told you there is very little association between your MRI picture and your diagnosis? That these pictures can lead to treating things that don’t exist especially in regards to pain. They can lead you down a path of spending hours or years of frustration, sunken medical costs with little to no results.
There are plenty of people with abnormal looking X-Rays & MRI’s who are in ZERO pain whatsoever. SAY WHAT!!!!!!!
Take back pain for example:
This graph is based off of a 2015 study looking at the backs of 3110 healthy, pain free people on MRI & CT Imaging.
Almost 70% of people in their 40’s WITHOUT back pain showed degenerative disc disease and were pain free.
As we would expect, the numbers increase in older populations but amazingly even people in their 20’s have a 30% chance of showing degenerative findings on imaging. These are all people walking around, bending, picking things up, playing sports or performing fitness activities without any symptoms whatsoever.
It’s Not Just Backs
We see similar findings in the some of the most commonly injured and painful areas of the body.
Shoulder A 2014 study showed equal rates of partial & full thickness rotator cuff tears on MRI between older adults with no shoulder pain and those with current or previous shoulder pain.
Hip In a 2018 study, MRI revealed abnormalities in 73% of hips including labral tears, cartilage defects, bony changes, fractures among other conditions. All of these findings were in people without hip pain. In other words, 33 out of 45 volunteers with no history or hip pain, symptoms, injury or surgery showed abnormal MRIs.
Knee In MRIs of the knees of pain free collegiate basketball players, 62% showed meniscus abnormalities, 90% showed patellar tendinopathy & 86% showed bone marrow changes. In the general population, up to 85% of adults without knee pain show knee arthritis on X-Ray. Crazy!
Why Does this Matter?
MRI only gives us a small piece of the pie. They don’t give us the whole picture! So many health professionals want some to give us a pill or a shot, or have a surgery, or put something back in place based on a MRI that is NORMAL in most people. Your body is not a car. We can’t just replace parts. We just aren’t that simple. We are more of an ecosystem with lots of moving parts and things are constantly changing and in flux.
Gone are the old ways of going to see your doctor ordering a MRI and then basing all your treatment on that MRI. At least we wish it was GONE! If your like most people, you accept this as routine procedure and the image results become the basis for every medical decision going forward. BUT THIS IS WRONG AND NOT GOOD MEDICINE. As you can see, there are people without pain who have “abnormal” MRIs and there are also going to be people with normal looking images that have serious symptoms. We need to take the whole person into account and spend time really looking at everything not just a ONE picture.
Don’t get me wrong and there is a time and a place for advanced imaging & medical intervention. It can save people’s lives. The fact is, the people who need surgery or something beyond conservative care in the minority.
Getting back to doing what you want to do and getting out of pain is so much more important than what it says on some piece of paper!
There is nothing wrong with surgery for people who truly need it but the fact is that this is the minority. Skin wrinkling is an normal part of the aging process too, so is getting weaker, so is getting stiffer Not getting into a chronic pain state is crucial.
https://onlinelibrary.wiley.com/doi/full/10.1111/1756-185X.12476 – shoulder article
https://www.ncbi.nlm.nih.gov/pubmed/23104610 – hip article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083196/ – pappas knee article
Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskeletal Disorders. 2008;9:116. doi:10.1186/1471-2474-9-116. – knee article 2
Girish G, Lobo L, et al. American Journal of Roentgenology. 2011;197: W713-W719. 10.2214/AJR.11.6971 – shoulder article 2