This is one of the most common questions I hear.
My short answer is: it depends, but most likely not.
Let me explain.
Oddly enough, the MRI isn’t the problem. It’s what happens after the MRI that's the problem.
The MRI itself is actually pretty awesome. You get to see what the inside of your body looks like and that can be interesting to see!
The problems start when you get the results explained to you.
“You have a tear in your rotator cuff”, “you have a bulging disc at L4-L5”, “you have a torn meniscus”, “there is a slight tear in your labrum”.
I have a tear in my rotator cuff? I have a herniated disc in my low back? I have a torn meniscus?
I don’t mean to downplay any of these issues, but without a recent trauma, does the diagnosis matter? In most cases I would argue not and here's why.
If this is from a problem you’ve been dealing with for over a few months, these results can have a nocebo (negative expectation of a situation) effect. Hearing the results from your image about how you are “damaged” or “injured” like this, can play a seriously negative role in how well you’re able to recover.
We have a rule at The Movement Schopp: You don’t have a bad (insert body part here), it’s just temporarily problematic. Our job is to find the reason it is problematic, then solve the problem for good.
Let me ask you a question. Do you think the mind is a powerful thing?
I have never heard anyone tell me they didn’t think it was, so let’s go through this scenario.
Imagine waking up every morning and telling yourself that you are going to have a bad day. What will start to happen? Every day will start to become bad before you even get the chance to have a good one. This same thing happens when you hear something like “you have a tear in your rotator cuff”, “bone on bone” in your knee, a herniated disc in your back, “your spine or hips are out of alignment”, etc.
Fortunately these results may not even be the cause of your pain. We actually see a very poor correlation between an MRI finding and the source of someone’s pain. Check out this chart below for example:
This is looking at over 3,000 people’s MRI results on their lower back. But here’s the interesting part: None of them were experiencing any pain at the time of the MRI. You can see that over ⅓ of people in their 20’s had some sort of disc degeneration or disc bulge without any pain. And the prevalence just increases each decade, but pain does not!
Maybe these “abnormal” MRI findings aren’t so out of the ordinary after all.
I can’t tell you how many times I have had people come into my office with knee pain from a “meniscus tear that they’ve developed after years of wear and tear on their knees”. When we assess their knee, it is fine. When we assess their hip, they may be relatively stiff and have some weakness. We look at their ankle and it is stiff. Then we address the issues we have found and low and behold (without even touching the knee), after a few visits their knee doesn’t hurt anymore.
It’s not magic, it's lifestyle change and improving how the body moves.
But let’s get back to the real question. Do I need an MRI?
To answer this question we need to answer these 3 questions first.
3 questions to ask before getting an MRI:
Is your goal to have surgery? If your goal is to have surgery, you will typically get an MRI first so the surgeon can have an idea of what is going on.
Do we think something systemic is going on or was there a recent trauma? This is a more serious reason. Something systemic means problems such as cancer, a tumor, a spinal cord issue, neurological diseases, a recent trauma, etc. Now, by recent trauma I mean something more along the lines of a car accident, not loading up a deadlift too heavy or doing too much volume in a workout and your back or shoulder is sore for a few days.
Do you just really want to know what the inside of your body looks like? This can be a reason as well. Maybe you are just curious to see what your shoulder looks like or what your spine looks like on an image. I would caution you to not overwhelm yourself with the results though (for the reasons we talked about earlier).
If you answered yes to any of these questions, an MRI actually might be the best next step in your recovery process, and this is definitely something you should be talking about with your primary care physician or surgeon who is directing your care.
Now that we’ve gone through these 3 questions, let's talk about 3 reasons to NOT get an MRI:
Your friend or family thinks you should. No offense to your friend or family member because I'm sure they are just trying to help, but they may not be the best resource to make this decision. Can you imagine going to your sibling and asking for legal advice? (assuming they aren’t a lawyer)
Something hurts. Because of the low correlation we see between MRI findings and pain, we know this is not the best reason to get an MRI. And again, it isn’t that the MRI is a bad thing, but once we hear those results, you can’t un-hear them. This is called the nocebo effect.
You haven’t tried any active treatments yet. What have YOU done to fix your problem so far? If the answer to this question is massage, ice, heat, rest, an adjustment, tape, cupping, or any other passive treatment, I would encourage you to try a more active treatment. This isn’t to say any of the previously listed treatment approaches are bad because they aren’t. I certainly use some of them when I feel they can be beneficial. BUT, if we do any of those to relieve symptoms without addressing the underlying weakness or stiffness causing the problem in the first place, it’s no wonder your problem hasn’t been getting better for good!
I hope this helps you decide if you should get an MRI or not, but even more importantly I hope it helps drive your decisions when looking for the best treatment for your pain or problem.
Your body will heal itself in most cases, you just need a guide to help put it in the right environment to do so.
If you’d like to schedule an appointment to get started on fixing your problem for good, click here so we can schedule a free 15 minute phone consultation to see if we’ll be the best fit for each other!
Build A Better You!
Dr. William Schopp PT, DPT, CF-L1, Cert-CMFA