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Low Back Pain: Should I get an MRI?

Many patients who come in with back pain and radiating symptoms that are of Lumbar origin ask whether or not they should get a MRI (Magnetic Resonance Imaging).  Before considering getting MRI, one should weigh the consequences of having images done.

The doctor will question you for certain Red Flags to determine whether or not an MRI should be taken.  These include the inability to pass urine or stool, difficulty controlling urine or stool, difficulty with walking and balance, severe back pain in children, etc. (1) These red flags are potentially very serious signs and would require further investigation and imaging.  However, outside of these red flag signs, it may be unnecessary to have images done.

Another important factor to consider is what options you have even after you do get an MRI done.  Regardless of whether you do get an MRI scan, doctors will usually determine a course of action that include conservative management (ie physical therapy, massage, acupuncture, etc.), medication, injection, and surgery.  Many times your primary care physician will choose to have you attempt physical therapy to see if you improve through conservative care.

Physical therapy has proven to be a very effective non-surgical treatment for symptomatic lumbar disc disease. (2) Treatment of low back pain involves teaching exercises, posture, and biomechanics (movement of the body) and performing manual therapy to allow the person to return to their previous level of function.

 MRIs can be very expensive.  Depending on your insurance and where you live, it can cost up to several thousand dollars.  Studies have compared patients that were referred for physical therapy versus those that had imaging done, and have shown that those referred for physical therapy created less medical costs. (3)

Studies have shown that asymptomatic subjects (people with no symptoms) commonly present with positive MRI findings including: disc bulge; disc herniation; spinal stenosis or even fractures. It is important to realize that disc degeneration is a “normal” age-related change. (4) This research demonstrates that MRI results are not necessarily definitive in explaining why a patient presents with particular symptoms.

It is generally a good idea to attempt physical therapy at first.  If conservative care is not helping (usually within 4-6 wks), the patient might be referred back to the MD.

- Duffy Chan, PT