MRI for Back Pain | National Spine Care | Downtown Calgary Chiropractor

Three Ways to Know If You Need an MRI For Your Back Pain

This would be where the new title goes

Back pain that goes on for too long begs the question: Should we get an MRI to find out what is wrong?

Some recent research sheds light on whether this approach is helpful. Old school thinking was based on obtaining a structural diagnosis. This meant pursuing tests and imaging to try and determine which structure(s) are causing your back pain. Is it the facet joint, the disc, the nerve, the ligament, etc?

Unfortunately, research has shown us that this approach hasn’t helped. Despite huge advances in diagnostic imaging approaches, our ability to diagnose and treat what is causing the pain in your back is quite poor. So the answer must be more MRI’s right? WRONG!

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What Does the MRI Show?

You have to feel sorry for the radiologists. They sit in dark rooms all day long reading these films of people they never meet. They have to rely on what us clinicians put on the requisition form to try and give them some insight as to why the patient is getting an MRI. So they read something on a form that says “Six month history of back pain” and then have to tell the practitioner everything they see on the film that they think may be contributing to your pain. They use awful, scary words like Degenerative Disc Disease, Bulging Discs, Herniated Discs, Stenosis or nerve compression are used to describe what people’s spines look like on the MRI. It gets better (and scarier) if they add an adjective such as “Severe”.

Here is the problem with MRI's

When treatment outcomes weren’t improving despite having all of these impressive MRI diagnoses, the smart researcher folks began to do MRI’s on people that didn’t have back pain. Guess what? You got it – Almost the same amount of scary stuff was seen on the people without back pain as those with back pain. Whoops!

Here is a summary of some recent research:

  • Age might make a difference: If you are 50 years old or younger there may be an association between the amount of degenerative change on your MRI and how much back pain you have. The problem is that >50% of asymptomatic (i.e. no symptoms) individuals ages 30-39 years of age had disc degeneration, height loss or even disc bulging.
  • Imaging findings of degenerative change are present in >90% of asymptomatic people older than 60 years of age. This includes things such as Disc degeneration, Disc height loss, Disc bulging, Disc protrusion (herniation) and facet arthropathy (Arthritis)

What does this mean?

What does this mean?

More and more we think that the degenerative changes identified on MRI’s are most likely part of our normal aging rather than a disease process responsible for out pain. As clinicians we get that if you are in pain, you become desperate to find a solution. So when faced with a question of getting an MRI lets look at things from a practical point of view.

Begin with the end in mind

The bigger question to ask is would getting an MRI dramatically change the treatment care plan? Lets assume you get an MRI of your back and now it has shown that you have degenerative changes in some of your discs, including bulging and protruding (herniated) discs. What should you conclude from these results? Two options:

  1. You can assume that the degenerative change shown on your MRI is normal for your age and are not causing your pain. OK, so then why are you in pain? What should you do about it?
  2. Assume that the degenerative change(s) shown on your MRI are causing your back pain. What can you do about it? We now know that they don’t recommend surgery for back pain most of the time anymore because the research has shown it either won’t help or can actually make you worse. Cortisone injections into arthritic facet joints may temporarily relieve your pain but the results are pretty inconsistent and deteriorate with time. So what do you do?

Time for a shift in thinking?

Both roads lead to adopting the New school thinking about back pain treatment. We need to move away from attempting to establish a structural diagnosis and form a functional diagnosis. Functional diagnosis means assessing your back’s function and trying to determine if your back is the culprit or a victim of other parts of your body not performing properly. Most back pain and injury is caused by repetitive strain. The joint-by-joint model of human movement popularized by Mike Boyle and Gray Cook gives us a wonderful way of examining your low back from a functional perspective. The best part is that it also gives us a great way to plan out the fix for any functional movements that may be overstraining your back.

If you want to know more about New School thinking for back pain treatment you can check out this article. We also go through this in much better detail in Spine Boot Camp classes and workshops.

Time for a shift in thinking

Both roads lead to adopting the New school thinking about back pain treatment. We need to move away from attempting to establish a structural diagnosis and form a functional diagnosis. Functional diagnosis means assessing your back’s function and trying to determine if your back is the culprit or a victim of other parts of your body not performing properly. Most back pain and injury is caused by repetitive strain. The joint-by-joint model of human movement popularized by Mike Boyle and Gray Cook gives us a wonderful way of examining your low back from a functional perspective. The best part is that it also gives us a great way to plan out the fix for any functional movements that may be overstraining your back.

If you want to know more about New School thinking for back pain treatment you can check out this article. We also go through this in much better detail in Spine Boot Camp classes and workshops.

Summary

Gord's awesome video

References

  1. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. Review. PMID: 25430861 [PubMed – indexed for MEDLINE] Free PMC Article.
  2. Brinjikji W, Diehn FE, Jarvik JG, Carr CM, Kallmes DF, Murad MH, Luetmer PH. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2015 Dec;36(12):2394-9. doi: 10.3174/ajnr.A4498. Epub 2015 Sep 10. Review.   PMID: 26359154 [PubMed – indexed for MEDLINE] Free Article
  3. Jensen TS, Albert HB, Sorensen JS, Manniche C, Leboeuf-Yde C. Magnetic resonance imaging findings as predictors of clinical outcome in patients with sciatica receiving active conservative treatment. J Manipulative Physiol Ther. 2007 Feb;30(2):98-108.   PMID: 17320730 [PubMed – indexed for MEDLINE]
  4.  Jensen TS, Albert HB, Soerensen JS, Manniche C, Leboeuf-Yde C. Natural course of disc morphology in patients with sciatica: an MRI study using a standardized qualitative classification system.   Spine (Phila Pa 1976). 2006 Jun 15;31(14):1605-12; discussion 1613.   PMID: 16778696 [PubMed – indexed for MEDLINE]
  5. Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C.Modic changes, possible causes and relation to low back pain. Med Hypotheses. 2008;70(2):361-8. Epub 2007 Jul 10. PMID: 17624684 [PubMed – indexed for MEDLINE]
  6. Jensen TS, Karppinen J, Sorensen JS, Niinimäki J, Leboeuf-Yde C. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain.      Eur Spine J. 2008 Nov;17(11):1407-22. doi: 10.1007/s00586-008-0770-2. Epub 2008 Sep 12. Review. PMID: 18787845 [PubMed – indexed for MEDLINE] Free PMC Article
  7. Herlin C, Kjaer P, Espeland A, Skouen JS, Leboeuf-Yde C, Karppinen J, Niinimäki J, Sørensen JS, Storheim K, Jensen TS. Modic changes-Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis. PLoS One. 2018 Aug 1;13(8):e0200677. doi: 10.1371/journal.pone.0200677. eCollection 2018.   PMID: 30067777 [PubMed – indexed for MEDLINE] Free PMC Article
  8. Albert HB, Sorensen JS, Christensen BS, Manniche C. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J. 2013 Apr;22(4):697-707. doi: 10.1007/s00586-013-2675-y. Epub 2013 Feb 13. PMID: 23404353

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