When To Get and Not To Get an MRI

What is an MRI?

MRI stands for magnetic resonance imaging. It is a medical imaging technique used to form pictures of the body. MRI machines are good to see non-bony, or soft-tissue structures (i.e. ligaments, organs, tendons). MRI scanners use magnetic fields, magnetic field gradients, and radio waves to do this. MRI’s do not have ionizing radiation like x-rays, CT or CAT scans, and PET scans.

When should I get an MRI?

MRI’s should be ordered sooner for red flag conditions. Red flags are conditions that impose a serious, sometimes life-threatening impacts on your health. Examples are aneurisms, cancers, and other problems of that nature. For musculoskeletal conditions, MRI’s should be used only if red flag signs are present based on the patient’s subjective and objective information. Musculoskeletal conditions are injuries that effect the body’s structure and movement. Muscles, tendons, ligaments, nerves, and discs are susceptible to injury. Although still serious, a lot of musculoskeletal injuries are not red flags.

I know something is wrong inside my body now. Why are MRI’s taken later for musculoskeletal conditions?

For musculoskeletal conditions, MRI’s are used as pre-operative tools. Meaning, you have a higher likelihood of getting surgery with your condition. MRI’s should not be used casually to “see what is going on” at any time. This is because what you see is not always be what you feel. That is proven by evidence. You will see a “horrible” MRI, but that person will have no pain. Or maybe a “perfect” MRI, but that person will have a lot of pain. This is common for generalized spinal pain. Sometimes, the image and the symptoms do line up together. If you have a knee injury (i.e. highly suspected ACL tear), your symptoms such as instability will match the MRI findings of a torn ACL.

Wouldn’t it help treatment to see what exactly is going on with an MRI now?

No. Physical therapists use a variety of test and measures to create a hypothesis, or explanation of what is wrong with your body (i.e. disc, muscle, ligament, or bony injury). With this information, your therapist creates a top, or most suspected, hypothesis. With that in mind, they then develop a treatment approach to allow proper healing of any suspected involved structures. For example, your PT says you might have a meniscal tear in your knee. They are not going to have you do things to further irritate the meniscus.

It’s important to also know that physical therapists are highly trained to evaluate movement patterns, strength, and mobility. This allows therapists to target your deficits. Deficits are things that your body lacks which contribute to your pain (i.e. balance, flexibility, strength). You are going to present with the same deficits with or without an MRI.

Failing Conservative Treatment

Failing conservative treatment means that you’ve tried a thorough round of physical therapy, but you still are extremely limited. In some cases, failing conservative treatment can warrant an MRI, particularly for joints like the knee and the shoulder. Generalized spinal pain can be different as MRI’s are poor explanations for a lot of spinal conditions as previously mentioned. Be honest with yourself, your primary care, and your PT when you are at this point. Did you try as hard as you could with your physical therapy at home? Are you willing to potentially get surgery?

Succeeding in Conservative Treatment

This is the best scenario. You are have reduced pain and are moving well. Despite feeling better, the original injury is still there. This may cause concern about arthritis and potential re-injury. Getting surgery now may actually increase your risk for complications. An MRI is not warranted at this point. Please refer to the analogy below to understand this concept.

Car Analogy

Your body is a car. You have that car for your entire life. No matter how hard you try to prevent it, you are going to pick up scratches, nicks, and dents on the inside and the out with time. You want your car to run as well as it can for as long as it can. Maybe your tire deflated (torn ACL), the engine temporarily gave out (heart attack), or you got a dent (scar). If the engine give outs, you need to take the car in right away. For other musculoskeletal conditions, sometimes getting an MRI without trying physical therapy first is like taking the car into a shop when you have the tools and a person to help guide you potentially fix things on your own.