With tremendous power to uncover the mysteries of body, why is it so difficult to get your doctor to order an MRI of your back? The answers to this complex question extend far beyond the limitations instituted by the insurance companies.
Magnetic Resonance Imaging, commonly referred to as MRI, is used to detect soft tissue injury throughout the body. MRI is different from conventional X-rays that only visualize bones; it uses a strong magnetic field to vibrate hydrogen atoms, forming a clear picture of the structures in the body. Offering high resolution, extremely fine detail and advanced diagnostic capabilities for countless diagnoses, MRI is the test of choice for most physicians.
At the top of the list is MRI's clinical usefulness. Because of MRI's strong ability to detect even the most minor details, it may provide information not relevant to the problem at hand. Let's take the classic example of the bulging lumbar disc with pain radiating down the leg. The first inclination is to "get an MRI of the spine to see what's going on." This is a dangerous thought process because most MRIs will detect abnormal findings even in healthy people. Thirty percent of people over 30 years old have at least one bulging disc of which they are unaware.
The nature of a bulging lumbar disc is to change over time. Many patients who have a repeat MRI several months later find no difference in the amount of bulge, yet are symptom free. Others discover that while the bulge has diminished in size, it may have shifted and is now pinching a nerve. Because of the wide variability of the information obtained from an MRI, a practitioner must not act hastily when reviewing the results. The most judicious use of these tests occurs when they are weighed against the physical exam findings from an office visit to see if the symptoms match accordingly.
While it is one of the safest tests offering detailed imagery of the discs, it must be taken into account that it is only a snapshot in time and does not give information about what happens to the discs while the person is moving. As a practitioner who works with bulging discs on a daily basis, it is exceptionally rare that I require an MRI to provide effective treatment. Physical therapists use special movement-based physical tests to uncover these injuries. By using a cluster of physical tests, we have the ability to accurately identify not only the extent of the injury, but all the structures contributing to the pain.
This brings us to the question of who is a good candidate for an MRI and when do we go forward with an imaging study? Patients who exhibit vast deficits in their strength, whose conditions are rapidly deteriorating or display "constitutional" symptoms such as loss of bowel and bladder should be scanned immediately. Additionally, patients who plan to undergo surgery should obtain an MRI as it assists in surgical planning.
The stress of having an injury can cloud a person's ability to think rationally about what needs to be done to begin the healing process. All patients should know that only rarely is early management of a case changed because of MRI findings. Since so many people improve fully with conservative management, and when asked, state that they would prefer a nonsurgical solution to their problem, the next logical step is to initiate a course of therapy.
When I meet people intensely focused on MRI findings, I express the importance redirecting their attention away from the deficits and toward their rehab efforts to set the stage for recovery. So if your doctor does not order an MRI, don't panic, you can still have a successful outcome.
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Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly..Questions may be submitted to On the Mend, c/o Salem News, 32 Dunham Road, Beverly, MA 01915 or e-mail features@eagletribune.com.
