One of the most commonly asked questions we field is “why didn’t my doctor order an MRI before sending me to physical therapy?” This is a great question with, of course, a multi-factorial answer.
1. The first and most important reason is that having an MRI is unlikely, in MOST cases, to change the course of treatment. Let’s walk through an example --
The patient is a 52 year old man (shall we call him Fred?). Fred does not have any recent injuries or major changes in activity, but he has been noticing some back pain when he gets up in the morning for the past week or so. Initially, Fred thinks he must’ve tweaked it after a long drive to his daughter’s lacrosse tournament and he decides to wait it out - it’ll go away on its own. Sometimes he throws some heat or ice on it after he gets home from work; maybe he takes a couple of ibuprofen to get through mowing the lawn this weekend. Unfortunately, it gets worse and worse over the course of two or three weeks. His wife talks him into seeing the doctor.
Fred goes to see his primary care physician who asks him some questions, has him try to touch his toes (ouch!), and tells him he would benefit from PT. Fred feels frustrated because clearly something is wrong, and how could a PT help if they don’t know what’s going on in his spine?
The answer is, the doctor is following a clinically-proven set of ‘rules’ that help them to determine what the most appropriate course of action is, and they know a physical therapist is educated in diagnosing and creating an effective plan of care for Fred’s low back pain. If there was any concern about the safety of Fred’s spine or any confusion on what was going on, his primary care physician would absolutely order the appropriate imaging to get him the best possible outcome.
2. The next component to answering this question, is that MRIs (and other imaging) often show false positives. 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. Things like degenerative disc disease, bulging disc, or spondylosis may sound scary written in your record, but really they can be very normal in most people and not cause any symptoms or pain at all. In fact, you would be hard pressed to find anyone with perfectly ‘normal’ anatomy like we see in our handy dandy textbooks (or Google image search). Abnormalities and degenerative changes ARE normal, and visualizing them on an image does not change how you present as a person in front of house and how we can help you.
3. Finally, MRIs are e x p e n s i v e. Thousands of dollars! So because of the above listed reasons, it is not financially responsible for you (or your insurance) to have an MRI when it may not change the course of treatment or even get you feeling better faster! MRIs are a wonderful tool when necessary, but to jump the gun can really hurt your wallet.
There absolutely are scenarios where diagnostic imaging is warranted! It may be before physical therapy, it may be during or after. Everyone’s path is different, and it is important to build yourself a healthcare team that you trust and feel comfortable working with. As your PT, we are honored to be in your corner as we help navigate you toward managing your pain and improving your function, helping to advocate for you and your needs along the way.
Stay well, don’t forget to stretch, and make time for yourself to be active. If you have any questions or concerns, don’t hesitate to reach out to us at BHPT. We’re here for you.