You Are Not Your MRI
When the discussion of an MRI comes up, I hear two main complaints from patients. One is the patient who is frustrated and doesn't understand why they have not yet had one, and how we as Physical Therapists can treat them without it. The other is the patient who has had one, and now is convinced that they will not improve because of what the films showed, as if somehow the pathology is a separate live entity which is free to do what it will to their body's. These are the patients who start conversations with "my disc herniation won't let me..." or "my sciatica doesn't want to..."
While your MRI may be an image of your own anatomy, it is imperative to understand that you are not your MRI. Presence of something that differs from the "norm," be it degenerative changes, disc bulge or herniation, increase or decrease in angle of lordosis, etc are all just that -- presence of something that differs from the norm. Certainly there are times when the pathology is severe, correlates with symptoms, and does not respond to conservative therapy. The point is that presence alone is not enough.
So often I hear patients express that their ability to heal, progress, or return to all the activities they enjoy is somehow not possible because of what their MRI films show as per the "my physician said this was the biggest disc herniation he/she has ever seen, and couldn't believe I was still walking."
REALLY? Act responsibly much???
As a healthcare practitioner, we must be mindful of our words and what we tell out patients. While there are varying opinions on this topic, there are many who view the MRI as doing more harm than good. Absent any 'red flags' that would trigger an immediate MRI being performed, there are many insurance carriers who have in their back pain protocols a stipulation that a course of physical therapy be completed before an MRI is obtained. Why?
Take this test: I want you to identify from the MRI images below which of the 3 patients is having low back pain currently and which has no pain and actively participates in all activities?
It's okay. Take your time, review them thoroughly, and I'll be here whenever you are ready to take a guess.
Because trust me, all you can do is guess.
There is no way to know who has pain and who doesn't just by looking at an MRI. Don't take my word for it, the research is pretty conclusive on this. Pain is an output, not an input. If there is no perception of threat by the brain, the then will not be presence of pain. Perhaps that is why some patients have "terrible" MRI films and have no pain, and others have "normal" or "clean" films but are in severe pain and can't function.
Is there a place for the MRI? Of course there is. But, let's try and be responsible. Let's evaluate the patient thoroughly and order diagnostic testing to confirm your suspicions or rule out others. Too often we see 'Reactive Medicine' being practiced where a battery of tests are ordered, and then a diagnosis is established. I have conversed with many MD/DO's of the 'old school' who will tell you that is absolutely backwards. Let's perform a good physical examination, with a solid orthopedic examination and movement testing (assuming the other system screens and neurological exam are normal) to identify movements that increase or decrease symptoms. Let's education the patient as to how pain works, and how based on the educated clinical decision you have come up with, physical therapy can help them (assuming that is the case, of course). If the conclusion is that physical therapy will not be helpful, or the patient warrants additional work up or another professional's skill sets, the educate the patient as to why you have come to that conclusion.
Here are a few pieces of literature to check out on a rainy day!
Living in pain is difficulty, it can also be unnecessary. If you are continuing to experience back pain or unresolved pain after an injury and you're in Las Vegas or Henderson, Nevada, then give Athletes Physiotherapy a call. If you haven't yet had physical therapy, this may be the conservative treatment option to get you out of pain and back to your normal routine. If you have already had physical therapy in Las Vegas or Henderson, but saw little lasting change, or were unhappy with the services you received then give Athletes Physiotherapy a chance and experience the difference first hand. Call 702-907-5105 or schedule directly from our website at www.athletespt.com.
Athletes Physiotherapy - Las Vegas, NV
Athletes Physiotherapy: specializing in High Performance Physical Therapy, Sports Physical Therapy, Dance Physical Therapy, Orthopedics, Athletic Training, and Performance Enhancement. Helping athletes, dancers, and active individuals in Las Vegas, NV & Henderson, NV get out of pain, move better, and achieving more!
Thank you for stopping by the Athletes Physiotherapy Blog! Kristopher Bosch founded Athletes Physiotherapy in Las Vegas, NV. He is a Father, physical therapist, athletic trainer, pilates teacher, & perpetual student!
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