When Should I Get An X-Ray or MRI?

X-Ray or MRI? Charleston natives are very active! We run, surf, exercise, and do all kinds of fun activities. Sometimes things happen and injury occurs. Now what?! Don't worry, Made 2 Move is here to help you get out of pain and back to doing the things you love to do!


“Should I get an X-ray or MRI?” This is a question that we get at Made 2 Move all of the time. This is one of the first questions many patients experiencing unexplained or chronic pain ask at the beginning (or prior to) their first physical therapy session. It seems logical that getting an image would help to “see” what the issue is or what is causing pain.


However, a recent study on spinal imaging “found no evidence that the use of routine or repeat radiographs [x-rays] to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients” (Corso et. al 2020). As we will discuss in future blogs, the “tissue is not always the issue,” which is one of the reasons imaging can be such an impractical step in resolving pain or injury.


The issue with imaging

  1. X-rays and MRIs can be an unreliable indicator of injury.

Studies have shown that ⅓ of asymptomatic people who displayed a disc bulge on an MRI never experienced any back pain. The disc bulge was likely a result of normal aging while their back pain was a result of weakness in the back that needed strengthening. Once a doctor points to abnormalities on an image or puts words like “arthritis”, “wear and tear,” or “disc bulge” in someone’s head, they are going to likely attribute their pain to that ailment and avoid the activities (lifting weights, movement, etc.) that could ameliorate the pain.


Studies have also been done on patients with pain in one shoulder that volunteered to get imaging done in the non-painful shoulder. What did the researchers find? The prevalence of abnormalities (arthritis, bursitis, partial tears) were just as common in the healthy shoulder vs. the painful shoulder. The same situation has been found in those with knee pain.


Similarly, there are those with debilitating pain whose x-ray or MRI comes back 100% normal. This is a display of the complexities of pain.


  1. Getting an MRI or X-Ray will likely not change the treatment plan

There is an expectation that getting imaging done will heal the injury because you’ll have an “answer” to your pain or be able to “see” what’s wrong. However, most times the image or answer an individual gets is not going to change the course of action that the PT takes in their prescription for recovery. Thus instead of being a solution, imaging is often just a waste of money + additional source of stress/fear for the patient.


  1. Getting an MRI or X-Ray can give “false positives”

Many times, imaging can display findings that aren't the true source of the pain. Best Health PT notes that, “if 100 healthy people over the age of 25 went in for an MRI of their low back, the radiologist would have something to report for the vast majority of them.”


The truth is that most people have a degenerative “abnormality” in some area of their body as a result of normal aging. They are probably unaware of this and completely asymptomatic. Thus, overdiagnosis or misdiagnosis can be a consequence of unnecessary imaging.


Alternative Solutions to Imaging

If there was an acute injury, or if following an initial assessment, the PT sees imaging as an appropriate measure, then by all means an x-ray or MRI should be done to assess the injury. However, in many instances, a thorough evaluation by a PT, resistance training, and movement can ameliorate the ailment without the assistance of an x-ray or MRI. Imaging can be expensive, fear provoking, and is not likely to change the course of treatment action. What are some alternative solutions to imaging as a way to get out of pain or recover from an injury?


  1. Instead of paying for an MRI or X-ray, put that money towards a gym membership or PT sessions.

  2. Be consistent with your training and PT exercises.

  • As with anything, consistency is key in injury recovery. Listening to your PT when they tell you to do rehab exercises 3 days a week, sleep more, or manage your stressors will likely expedite recovery and reduce risk of future injury.

  1. Find a PT you can trust.

  • You should feel as if your PT is listening to you, explaining things thoroughly, and not just rushing through to the next patient.



Find a doctor you can trust

Here at Made 2 Move, our goal is to see you as few times as possible and order x-rays or MRIs only if absolutely necessary. Our therapists strive to educate our patients, listen to our patients, and avoid imaging unless it is warranted.The expertise our PTs have in performing evaluations often surpasses the information an x-ray or MRI can give you. This is why we perform thorough evaluations and send patients home with resources and exercises to perform on their own.


Worded perfectly by Dr. Cosman of Whole Body Health Physical Therapy, “Physical therapists are skilled at deducing a probable diagnosis based on special test findings during your examination and your personal report of symptoms. With active and passive movement based tests, we are able to work out if it is soft tissue versus skeletal; muscular versus ligamentous; degenerative versus acute."


While this can be important for physical therapy rehab, it is also vitally important that we take a look at your stress, sleep, nutrition, and system as a whole. At Made 2 Move, we are not just treating the symptoms, but the whole person. It is our responsibility to educate patients on how to manage their current pain or injury, and we believe this is entirely possible without imaging. Looking to set up an initial evaluation? Email frontdesk@made2movept.com today!