Treatment Before an MRI
By Ehren Allen, DPT/Certified Orthopedic Manual Therapist
Should I Have Treatment before an MRI?
The cost of healthcare has skyrocketed over the past 30 years. Healthcare providers are being forced to consider ways to try to cut unnecessary costs. Insurance companies are not as quick to authorize some tests such as MRIs. But this hits a nerve with many people. If you have an injury, you should have an MRI before having any treatment, right? That may not always be true. Let me explain.
What is an MRI?
An MRI, or Magnetic Resonance Imaging is a diagnostic test that gives an image of the inside of the body. MRI imaging can show things like muscle strains and herniated disks. Soft tissue injuries may show up on an MRI. An X-ray is typically only useful to see bone structure. It is not very helpful with soft tissue injuries.
When did MRI start to be used?
The MRI was introduced in 1973. Since that time, it has grown into a useful tool for detecting cancer, internal abnormalities, disease processes, and soft tissue injuries. Doctors began to order MRIs for many injuries, and by the 1990’s, many physicians in the United States were ordering them as a standard for patients with back pain or other orthopedic injuries.
What was the Problem with Ordering a lot of MRIs?
There are several problems that can come from ordering MRIs frequently.
- Cost– MRIs are very expensive and increase the cost of care for injuries.
- Time– MRIs take time to have performed and then read. This is time that can be used in treatment.
- They Are Not Always Helpful – MRIs are not foolproof. It has been well documented that false negative and false positive findings may sometimes occur. An MRI is only a picture of one point in time. Injuries can heal and tissue can change after an MRI is performed.
- They can lead to unnecessary anxiety over a minor injury. – It’s kind of like taking your car to the shop. If you look under the hood, you’re going to find something that doesn’t look normal. We all have anomalies that may not look normal but it does not necessarily mean it is a problem. Sometimes when something is noted on MRI, patients can become fixated on a problem that may not be the source of the symptoms. This can lead to patients avoiding activity for fear of causing a bigger issue.
Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good. Timothy W. Flynn, PT, PhD, Britt Smith, PT, DPT, Roger Chou, MD. Journal of Orthopaedic & Sports Physical Therapy. Published Online:November 1, 2011 Volume 41 Issue 11 Pages 838-846. https://www.jospt.org/doi/10.2519/jospt.2011.3618
There has been much debate on this topic over the last 10 years. After all, shouldn’t the doctor decide whether you need an MRI, not the insurance company? Well, it’s not that simple.
Companies like Starbucks began to look at the healthcare costs of their employees back in the early 2000’s. They looked carefully at the treatment of Low Back Pain and how it was managed medically by the Virginia-Mason Health System in Seattle, WA. They found that the majority of patients who went to the doctor due to lower back pain were getting MRIs and invasive treatments, but the outcomes were not that good. They also found that most of those patients went to physical therapy as the last point of treatment. After looking at the results, they found that most patients did not start to improve until they began physical therapy.
They made a decision with the insurance company and the healthcare System, to have patients with Low Back Pain start physical therapy as the first line of treatment, before ordering MRIs. They found that patients recovered faster with better outcomes and significantly lower overall cost.
Some insurance companies took notice of this and found that many patients with injuries improved without the need for an MRI. Thus, it is now very common for insurance companies to require patients to try conservative care before authorizing an MRI. There are obviously exceptions to this if there are “Red Flags” that something serious or sinister is causing the symptoms.
Why Does Physical Therapy Help with Low Back Pain?
Back pain is a big problem. 80% of the population is going to have Low Back Pain at some point. But most of the time, patients get better in about 6 weeks. Physical therapy can help to progress this with proper exercises to treatments to lower pain levels and help people to function properly. By learning proper movement patterns, there is less of a chance of re-aggravating the lower back pain.
If there are more serious concerns, physical therapists are highly trained to identify issues that need immediate medical intervention.
What if I Still Hurt After Physical Therapy?
If physical therapy does not help, then it may be appropriate to have an MRI. An MRI may be helpful to identify any issues that need medical or even surgical intervention. But, it is important to try conservative care first if possible.
What Do I Do If I Need Treatment for an Ache or Pain?
The quick answer is to go to the doctor. Jacksonville Orthopaedic Institute offers state of the art treatment options to treat painful joints and soft tissue. We offer conservative care with our rehabilitation centers, all the way to advanced diagnostic and surgery options if needed. This allows JOI to keep the healthcare costs for orthopedic issues as low as possible, while keeping the quality of care as high as possible.
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