“Do I Need an MRI” (…for my back, neck, knee or shoulder pain)

Feb. 9, 2018

This is one of the most common questions the therapists and I get at clinic on a weekly basis, second only to “What’s going on, and can you fix it?” And while the answer varies depending on the situation, I’m going to do my best to answer the MRI question for you today.

But first, just a little background on the MRI, in case you’re not all that familiar with it. When our patients come to us with things like back, neck, knee and shoulder pain, it’s very common that they’ll already have had an x-ray of the involved area. And the x-ray is a very nice tool for viewing bones and cartilage, giving you information about things like possible fractures and arthritis.

An x-ray will also show you the size of the discs in your spine, which tells you if you have any degenerative changes (aka “degenerative disc disease”).

But what if you think you have a tear in one of the muscles, like the rotator cuff muscles in the shoulder? Or how about if you think you have a bulging disc in your neck or lower back?

In this case, the x-ray can’t help you, as you can’t visualize these changes. This is where an MRI comes in handy.

So if you think you have a rotator cuff tear or a bulging disc, the question again is “Do you need an MRI?”

Here’s the simple answer: No, you don’t necessarily need an MRI.

Now let me explain: Let’s say you’ve been having shoulder pain for several months, and you suspect that you have a rotator cuff (RC) tear. It might make sense to get an MRI to see if you do in fact have a tear, especially if you think you might need surgery.

But before you opt for the MRI, stop and consider a few things.

• First, small tears in the RC muscles are fairly common, and most of them don’t require surgery.
• Second, if you’re like most people we work with, you’ll do just about anything you can to avoid surgery.
• Third, if you can eliminate the pain in your shoulder and restore full use of your arm, you’ll probably be pretty happy, even if you have a small tear in one of the muscles.
• Fourth, larger tears in the RC are fairly easy to spot with a few quick tests in the clinic.
• This same thought process applies to a bulging disc: they’re very common, and few of them require surgery. Most respond to things like physical therapy, and severe disc bulges/ruptures are fairly easy to spot by our PTs.

I know that’s a long answer to a short question, so let me summarize those 4 points: even if you find some structural damage on your MRI, it’s very likely you can eliminate your pain and return to your activities without surgery. MRIs are most useful if you’re at the point where you’re considering surgery.

So what should you do if you think an MRI would show damage to something like a muscle or disc? Here’s my best advice:

• Step 1: figure out if conservative treatment (like physical therapy) can help you
• Step 2: ask your physician or PT if you need an MRI
• Step 3: act quickly. If you do in fact have significant damage that isn’t going to respond to conservative care, the faster you determine that you do need surgery, the better.

That 3rd step is a pretty important one. While the majority of people will respond to conservative treatment and make a full recovery, there’s a percentage of those who unfortunately won’t. And the sooner these people figure that out, the sooner they can fix the involved structure and minimize any permanent damage.

I hope that information helps clarify things regarding the need for an MRI. And if you’re still not sure if you need an MRI, feel free to reach out to me with your specific questions by emailing me at Luke@GordonPhysicalTherapy.com