MRI and low back pain…Do I need one?
Updated: Dec 8, 2019
Low back pain is an issue that most of us have experienced. About 80% of people will experience low back pain at some point in their lifetime. Management of low back pain can at times be very difficult because a lot of information is out there. With advancements made in technology, we assume that these approaches should help.
MRIs are a vital tool within our healthcare system and can be useful in helping to add another piece to the puzzle. However, in some cases they can actually complicate the diagnosis.
A literature review found the following:
Brinjikji et al. (2015) Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology 2015 Apr;36(4):811-6.
“Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient's clinical condition.”
“The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.”
The conclusions from this review indicate that spine degeneration and disc protrusion/bulge may be normal, especially in an aging population; perhaps they are just part of the normal aging process. Caution should be used when trying to interpret findings on an MRI with someone presenting with low back pain symptoms that do not quite fit the clinical presentation, and we should not base a diagnosis solely on MRI findings.
How then do I manage symptomatic low back pain?
An evidence-based approach to the treatment of low back pain is recommended. Management should include a thorough clinical assessment by a physiotherapist to determine the source of the pain and any limitations in strength and mobility. The physiotherapist should then prescribe appropriate exercises to manage the low back disorder. There may be a short period of time where rest is required but movement and strengthening exercises have been shown to be most effective treatment in the management of low back pain.
If you are experiencing low back pain, contact the clinic and book an appointment with one of our physiotherapists.