Get The (WHOLE) Picture: The Truth About X-Rays & MRIs

“Do I Need an X-Ray or MRI?”

This is a very common question that we healthcare providers get asked, and it’s one that doesn’t have a black-and-white answer.

I get it; it’s tempting to want to know exactly what the problem is or what is causing your pain. Well, the human body is way too cool and complicated for that, and an image like an x-ray or MRI doesn’t give the whole picture. This can be confusing and frustrating, so let’s clear a few things up.

WHAT AN IMAGE CAN’T ALWAYS DO

An image CAN’T tell you “what” is causing your pain. Pain is weird. Like, really weird, and is influenced by a ton of factors such as past experiences, movement patterns, sleep, nutrition, and stress. We can’t look at an x-ray and confidently determine that one specific structure is driving your pain experience because it’s simply a picture of your body at a moment in time.
To help prove this point, we can look at MRI studies of COMPLETELY PAINLESS individuals. No current pain OR history of pain. 87.6% of people had disc bulge in their neck and 80% of 50-year olds had “disk degeneration” in their lower back. Almost 70% showed signs of a hip labral tear! As a rehab professional, I love this kind of information because it tells me that there’s more to the picture than the structure of the joint.

An image CAN’T show what your body is doing during daily activities. If you think about the position that you’re in for an MRI, it’s typically lying flat with your head on a pillow. This is a comfortable position where most people don’t have a ton of issues. We don’t get to see what your body is doing during things like picking up a heavy box or reaching for something up high on a shelf. Again, this is where skilled eyes and hands are so helpful in figuring out why a movement can be contributing to pain.
WHAT AN IMAGE CAN DO

An image CAN rule out scary stuff. If you have a history of cancer or trauma, an image can detect crazy things like tumors or fractures. These things are present regardless of what position you’re in and don’t respond to conservative therapy treatments. Doctors, Physical Therapists, and Chiropractors are trained to look for and ask about these things, but it’s important to provide a detailed health history.
An image CAN provide more information in a stubborn case. When put in context with the other factors mentioned (movement patterns, stress, sleep, etc), an X-Ray or MRI can help paint the picture of the pain experience.
If pain or weakness has persisted despite 1) a thorough examination AND 2) dedicated treatment by a professional AND 3) diligent work at home, then imaging may help guide treatment decisions. It’s imperative that ALL 3 criteria are met here, otherwise we’re just paying a bunch of money for information that likely wasn’t necessary. We want to use any newly-found information from an image as a supplement to what we already know about YOU and your environment.

To sum it all up, you are MORE than your X-Ray or MRI. The whole picture of your pain or limitations is best understood when multiple factors are considered. Imaging can be helpful if we’re suspicious of something scary or if you’re not responding to a well-rounded treatment plan. Regardless, the responsibility is shared by you (the patient), and your health care provider to understand these important factors and make treatment decisions accordingly. If you’re struggling with nagging pain and curious about rehabilitation options or the need for imaging, one of our passionate providers will gladly dive into this with you!

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