Alex Bocchi, PT, DPT, AzOPT Goodyear Physical Therapist
Low back pain is something most of us will experience at some point throughout our lives. Some of us recover within days while others may have ongoing pain for years. A licensed physical therapist evaluates the root cause of your low back pain to identify how, why, and when it hurts while also creating a personalized treatment plan to help you get back to pain-free living. Most of the time, we can do this without further testing, including an MRI. However, patients will often delay physical therapy for an MRI or ask if an MRI is necessary.
First, it is important to note that results from MRIs on low back pain can often be misleading. Many of us may have a previous disc bulge or injury present from prior years to your current pain episode. According to one study of 98 people without low back pain, 52% had a disc bulge at one level, 27% had a disc protrusion, and 1% had a disc extrusion. Furthermore, a study of 189 people under 30 with low back pain showed that 23% of those scans did not show any structural damage that could be indicative of their pain.
An MRI is best prescribed if the following is present and/or suspected:
* Spinal infection
* Fracture even with a negative X-ray test
* Severe/progressive neurological deficit
* Change in bowel/bladder function
* Sudden unexplained weight loss
* Severe and progressive low back pain
* Subacute or chronic low back pain with radicular involvement unresponsive to conservative therapy
* Cancer
The first step to navigate your road to recovery should be physical therapy. Together with your physical therapist, discuss symptoms and duration of symptoms to address the need for further testing as well as develop an appropriate plan of care for you. Your physical therapist will also have the knowledge to discuss potential red flags that warrant an immediate MRI. If an MRI is not warranted immediately, your therapist will begin your treatment program based on your preferred movement pattern to help manage your symptoms. Staying compliant with your home exercise program and listening to the recommendations of your therapist will set you on the right path to recovery. If after 6 to 8 weeks conservative treatment has not yielded any change, your physical therapist may discuss additional testing, including an MRI, at that time.