Should I Get an MRI? Mythbusting MRIs as a Physical Therapist

One of the hottest topics in the medical world are MRIs.

Our physical therapy patients are constantly enquiring with us about when to get one, so we wanted to share our thought process behind MRIs to clear up some common misunderstandings and a guide on when they are (and usually aren't) helpful.

Many people view MRIs as the end all be all.

And while there is some truth to that, we've found that many people have a lot of misconceptions around what an MRI can actually tell you and when that is (and isn't) useful.

We would even go far enough to say that sometimes MRIs can actually be problematic by highlighting issues that aren't actually problems (red herrings) that didn't exist before.

For instance, check out this crazy study where a women with low back pain got 10 different MRIs and received 49 distinct findings - none of which were consistent across all 10 MRIs.

That all being said, they are sometimes the best next step.

Want to skip to the chase? We offer free discovery calls where we would love to listen to what is going on and let you know what we think are your next best steps.

So here are the top situations where we, at Performx Physical Therapy, would refer someone out to get an MRI

(hint: it doesn't happen very often)

1. We're progressing through a physical therapy plan of care, but the needle has stopped moving. 

You come in for a hurt shoulder that we find is a tendonitis problem. We've been working through performance physical therapy for 8 weeks and have made good improvement, but there is still a specific area causing pain. This is unexpected and not what we should be seeing at this point in your recovery - there is something else going on.

I refer you to an MRI, which confirms our suspicion - there is a cyst under your labrum, which is why that specific movement still has associated pain. 

2. You have a very specific type of tear that cannot be healed without surgery.

You come in to Performx Physcial Therapy Clinic because you hurt your knee and it frequently locks up. We do an initial eval and determine that you have a bucket-handle tear on your meniscus, but want to confirm our findings as this type of tear requires surgery and other tears can sometimes present 'pseudo' locking symptoms.

Your MRI comes back confirming the bucket-handle tear and we can now take the next steps to prep for a surgery we're 100% positive is necessary. 

(Just want to throw in here - not all tears require surgery)

3. We come across "Red Flags" during your physical therapy evaluation

During your evaluation for a back injury we come across a handful of things that don't fit a normal pattern, ie red flags. In physio terms, we call this having a high 'index of suspicion', meaning there's something else going on outside of the muscles, joints, or bones. 

Here we refer you for an MRI as I want to confirm that physical therapy is the right choice, as more likely whatever is going on should be addressed with your medical doctor. 

A word that is used very intentionally in all of these situations is "confirm."

MRIs are for confirmation, not diagnosis.

Clinical assessment is accurate.

An MRI is a tool that allows us to improve accuracy and rule out the bad stuff. 90% of the time what we think is going on clinically is actually the case and an MRI will only confirm what we know or add a little more detail to the picture.

One last thing - there are potential risks of getting an unnecessary MRI. 

An MRI is not going to tell you why you have pain in your shoulder. Instead it may come back with misleading clues (a bursitis or calcified tendon), which although are a symptom of the problem, are not the real problem at all. It can create confusion in diagnoses or bring up a whole new "problem" which didn't exist prior.

Think of the woman we alluded to at the start.

She got 10 separate MRIs for low back pain and there wasn't a single finding that all 10 MRIs agreed on. And between all of the scans, she was alerted to 49 different 'problems' with her low back. 

Or take this study where people with healthy, pain-free knees got a 'test' MRI. 

The results? According to the MRI findings, 33% of these people with good feeling knees had osteoarthritis 🤨 

We hope this is helpful, as we get asked about MRIs a lot. They are an amazing tool when used correctly, but most of the time aren't necessary.

If you have any questions about MRIs, past results you've received, or are thinking about getting one, book in for a discovery call below. We would love to hear what's going on & let you know what we would suggest as the next best step.