Do I need an MRI or x-ray before Physical Therapy?
A common question we hear as Physical Therapists - how are you going to treat me without seeing my MRI? (Or variations of this - why do I need to see you before I have an MRI? Don’t you need a diagnosis to treat me? Etc). To answer this question, we need to start with what we actually look at during our Physical Therapy assessment, and how that guides our treatment.
We know that patients like to have a diagnosis. For most people, it is comforting to feel like you know exactly what is causing your symptoms (more on why what you see on your MRI may not actually be causing your pain later in this post). In some cases your diagnosis and MRI results may help us to explain what we think is contributing to your symptoms, the results generally do not change our treatment plan. We assess how you are moving, what areas are limited, and what movements and activities reproduce the symptoms that brought you in to see us. This movement based assessment is what drives our treatment.
There are certainly situations where an MRI and/or other imaging is necessary. For example, if there is a traumatic injury such as a motor vehicle accident, imaging may be indicated to rule out serious injuries such as fractures prior to beginning some Physical Therapy treatments. But for most injuries, a Physical Therapist can treat you just as effectively with or without imaging. In fact, imaging can often be misleading in regards to what is actually causing symptoms. A study completed by Wood et al revealed that thoracic spine disk protrusions occur in approximately 37% of individuals presenting with no symptoms. Additionally, it has been well documented through research that MRI findings in the lumbar spine are not associated with symptoms. An MRI can be very useful for individuals presenting with “red flag” symptoms, however in those with non-specific low back pain, imaging has actually been shown to worsen patient outcomes. A patient may find out that their imaging reveals disk degeneration, bulging disks, or arthritic changes (stenosis). This knowledge makes the patient feel like there is something seriously wrong in their spine that may not be able to be fixed, and promotes fear of movement, when in fact these changes are often just part of the normal aging process. It is important to remember that pain is complicated and involves many systems, so a still image on an X-ray or MRI is really only showing us part of the story. And that part of the story may or may not even matter in your recovery.
This is why we promote seeing a Physical Therapist first when it comes to musculoskeletal conditions. We can assess how you are moving, develop a treatment plan, and often get you back to the activities you love without the need for costly imaging and extra visits to see your physician. During the screening process if we feel imaging may be indicated before we continue, we will refer you to an appropriate provider right away.
Questions? Reach out to us at firstname.lastname@example.org.
Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS