You are not your MRI/X-ray

As a first-time patient you arrive in our clinic, possibly anxious, in pain, and probably had some imaging performed or are scheduled to have an x-ray or MRI. You may present me with your images and the report. As a physical therapist, I am trained to look at images and read reports. Even though it is natural to assume that your images should describe why you’re in pain and determine the outcome of your rehabilitation: Imaging does not show pain. Imaging needs to be correlated to your history, clinical tests, and your specific pain presentation.

When the image is read by a radiologist their job is to report any finding that is not what you would find in a typical image. For certain diagnoses, a broken bone, tumor, problems with organs and blood vessels the imaging directly determines the treatment. If you broke a bone you will get a cast or a surgery. If a tumor is discovered, you will undergo a specific treatment protocol. If a blocked blood vessel is found in your heart you may have surgery. Concrete answers.

For certain orthopedic issues, the lines are not as clearly drawn. As we age and use our bodies, we all incur different bumps and bruises along the way. Imaging can be a reminder of our past. Just because you had some specific “anomaly” on an image doesn’t mean it causes your pain.

The most common abnormalities found on imaging are osteoarthritis and disc bulges. Osteoarthritis is an expected finding when someone is middle-aged or older. It becomes a significant finding when it looks different than the other side, is more advanced than expected, or is correlated to what you are feeling. Regarding disc bulges, studies have demonstrated that at least 1/3 of people with a disc bulge on their MRI never had any history of back pain.

Imaging is only one piece of the puzzle and it may or may not be significant. It is a thorough clinical evaluation that ultimately guides me to the source of your pain.

Interesting Fact:

30% of 20-year-olds

60% of 50-year-olds

84% of 80-year-olds

….have disc herniations and no pain.

Image via Flickr | Cory Doctorow

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