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MRI Education

Let's start off by saying that MRI scans are very useful in certain situations, typically in situations where a clinician may suspect serious or sinister pathology. If you had back pain in conjunction with bladder or bowel changes, changes to your sexual function, numbness around the saddle area (groin, genitals, back passage), sciatica in both legs, weakness or decreased power in your legs, then this might be an indication for an MRI. There is another page on the website that goes in to cauda equina syndrome in a bit more detail. If we suspected a fracture, infection, spinal tumour or metastasis this could also be an indication for an MRI. However, these conditions are very rare and account for between 1-2 % of people with low back pain.


Despite the evidence advising against it, over imaging is a huge problem in healthcare, particularly for those with low back pain.

We now have the benefit of many different studies that have completed MRI scans on people with back pain and people without back pain comparing their MRI findings. This study completed in 2015, looked at the MRI findings of over 3000 asymptotic individuals, that means people with no back pain at all! 

If we have a look at the MRI scan findings down the side of the table and peoples ages across the top, the percentage scores are how many people of the 3000 had those findings. Taking a few specific results, 30% of pain free 20 year olds had a disc bulge on MRI and nearly 100% of pain free 80 year olds demonstrated disk degeneration. As a result we can confidently say that findings like disc degeneration, disc bulges and facet degeneration are a normal part of the aging process a little bit like grey hair and wrinkles but on the inside. 

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In a perfect world we would have knowledge of this information prior to having an MRI scan so that we have an idea of what to expect in context of our age. Unfortunately, more often than not, this is not the case and people are often given these result without education or context. Without context findings like disc degeneration, disc bulges and facet degeneration can be worrying and concerning, for the majority of us, it is scary medical jargon, unless explained otherwise. It can make us feel that our spines are vulnerable or damaged and we tend to associate degeneration with symptoms that are inevitably going to get worse. This can lead to negative health beliefs and behaviours, avoidance of movement and catastrophising. These factors are associated with making things worse, not better. Conversely, receiving MRI results in context of your age can provide comfort and reassurance, in turn decreasing worry, anxiety and fear of movement. 

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A 2013 study by Webster et al, compared two groups of people: those who had an early MRI as part of their treatment for sciatica and those he did not have an MRI. They concluded that early MRI's had a strong iatrogenic effect regardless of how severe the sciatica was. Meaning symptoms were made worse by having an MRI. The early MRI group reported more days of disability, more days off sick and significantly higher medical costs than the group who did not receive an MRI at all. In many services across the U.K. non-specialist services, such as GP's, are no longer allowed to order MRI's for people with low back pain for this very reason, unless suspicious of serious pathology, as specified by The National Institute For Health and Care Excellence. 

If you are worried about your MRI results then ask your therapist to explain them to you. There are a number of different physical tests that they can complete with you to see if your results correlate with the symptoms that you have or whether the results are more likely to be incidental or normal age related findings.

Physical Therapist
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