If you’ve been to your doctor for any kind of back pain, neck pain, shoulder pain, etc. you might have received some sort of imaging, whether it be an X-ray, MRI, or CT scan. Or, if you haven’t received imaging yet, but you’re in pain and concerned that it might be something serious, maybe you think you need to have some imaging done to see what’s going on.
I’m here to tell you that maybe that isn’t the best first option (at least in many cases). Now, don’t get me wrong, imaging can be crucial in cases of serious medical conditions. Fall down a flight of stairs and hurt your ankle? Probably should get an X-ray to make sure it’s not broken. Land wrong during a game of pick-up basketball and hear a snap in your knee and now you can’t walk? An MRI might be a good idea. In cases of a serious trauma, imaging usually needs to be the first stop to rule out fractures or ruptures. Especially if you can’t walk. But shoulder pain from weight-lifting or nagging low back pain that’s plagued you for years? Probably don’t need an image right away! And here’s why:
- An image is simply that—a picture of your anatomy at a moment in time. It tells us nothing about you as a person—how you move, your lifestyle habits, the state of your nervous system, etc. We know that pain is much more complex than just a picture of your anatomy! You cannot see pain in a picture; you just can’t. Pain is a multifactorial experience that is unique to everyone. If it was as simple as looking at a picture to identify what was wrong, 100% of back surgeries would be successful.
- The more we’re learning about imaging, the more we’re discovering about normal anatomical changes. For example, maybe you’ve received an X-ray of your back or neck and heard that you have some “degeneration” occurring, or maybe even a disc bulge. Or maybe an MRI of your shoulder revealed a rotator cuff tear. Scary, right? Wrong. The great news is that we are learning a lot of these “degenerative changes” in the body are actually completely normal (especially as we age!) and aren’t necessarily pain generators. I like to think of them as wrinkles on the inside. Simply normal changes that occur as we age and go through life that don’t have to hurt, just like the wrinkles on my forehead don’t hurt.
- Here’s some quick stats on this. A recent study took a group of completely ASYMPTOMATIC patients and MRI’ed their shoulders. What they found was pretty crazy. 20% of the patients showed partial rotator cuff tears, and 15% showed FULL thickness rotator cuff tears! And even crazier, in those 60 years and older, HALF of them had either partial or full thickness tears. And yet none of these people had any pain.
- Studies also show that lumbar disc degeneration (“arthritis”) is present in 90% of people ages 50-55. And in healthy young adults ages 20-22 with no back pain, almost HALF had a degenerated disc, and a fourth had at least one bulging disc. Again, these people had no pain.
So what is the big takeaway here? There is no consistent link between imaging results and musculoskeletal pain. That is why I’m such a huge believer in assessing people’s movement patterns, classifying pain, evaluating people’s coping mechanisms and thoughts and beliefs about their pain, then coming up with treatment plans tailored accordingly using a combination of hands on techniques and movement strategies. Movement is medicine, people. Tendons, joints, and ligaments heal with blood flow and load and often do very well with the correct exercise prescription and education.
It can be easy to think that if your MRI shows you have a rotator cuff tear, you need surgery to fix it. Think about it. If you have shoulder pain from improper movement patterns in your shoulder girdle, then you get surgery to fix the tendon but have done nothing to change the movement pattern, have you really addressed the root cause of your pain and been provided with long term relief? (Hint: the answer is no). It’s always worth a round of conservative, non-operative care before jumping into surgery.
I want to reiterate that imaging and surgery are not bad things, but they can become bad things when they’re not warranted. Surgery is a massive investment! We should be absolutely sure it’s needed before doing it, and we should be certain that there’s not a better treatment alternative. As healthcare providers, it is our responsibility to properly direct our patients to the right place for treatment and work together to ensure we’re not over-utilizing imaging, surgery, and medications. It’s also our responsibility to thoroughly educate people on their specific injuries, their imaging results, and the best treatment options for them. Will the system ever be perfect? Of course not. But when I get overwhelmed thinking about all the progress there is to be made, I remember that I can control what’s in front of me—doing the best I can with my patients, establishing great relationships with other providers in my community, and working tirelessly to make healthcare, at least in my city, more cost-effective and patient-centered.
If you have imaging results or an injury you’d like to discuss with someone, I’d love to help. I offer free phone consultations to discuss more in depth your specific case and how The Body Lab might be able to help. All contact information can be found under the contact tab.