You Think You Need an MRI But Do You? Chiropractors in Southampton Advise You.

MRI was introduced in the late 1970s and since then it has been incredibly helpful in diagnosing problems that just could not be detected on ordinary x-ray.

We imagined that MRI would also be able to definitively diagnose the cause of a patient’s low back pain. Unfortunately, this has not turned out to be the case.

MRI will show disc tears, bulges, herniations, joint arthritis, tumours, inflammation etc etc – all sorts of interesting stuff so it shows up issues with the back for certain but are those issues necessarily the cause of your particular problem that you have today? MRI cannot tell us that!

Just because you have back pain or leg pain and you see a disc problem on MRI it should not mean that you automatically need surgery to resolve it. MRI should be seen as a useful tool with which to demonstrate a process that may be occurring in a disc rather than using it as a means of being able to absolutely pin down the cause of your pain.

Lots of problems are due to the fact you are moving incorrectly or have weakness in muscles that cause you to overload tissues such as the disc. If we show you how to move properly and to strengthen those muscles that are weak then the chances are you will stop traumatising the tissues and the disc issue will be allowed to heal and the pain will resolve.

Patients often think that they must have an MRI to be able to see “what’s wrong”. Actually, a well performed cluster of tests that we perform in the clinic and a well performed history by your chiropactor are all that is needed in the early stages to determine the best course of action in your treatment plan.  Some studies have pointed out that early use of MRI in back pain cases results in increased surgical interventions with absolutely no improvement in outcomes.

These days, the standard of care is to first intervene with conservative procedures. That care may consist of exercises from your chiropractor along with passive pain management and/or massage or acupuncture.

During treatment sessions, we can continually monitor your symptoms, whilst reassuring you and giving you  recommendations. Painkillers from your GP may help as may muscle relaxants for a short period.

If those interventions don’t work then MRI might be warranted to help inform the next level of intervention. It is however, suggested that following examination and if appropriate, you give the conservative route an opportunity before pushing MRI.

References

http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

Majlesi J, Togay H, Unalan H, Toprak S. The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. J Clin Rheumatol. 2008 Apr;14(2):87-91.

van der Windt DA, Simons E, Riphagen II, Ammendolia C, Verhagen AP, Laslett M, Devillé W, Deyo RA, Bouter LM, de Vet HC, Aertgeerts B. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010 Feb 17;(2)

Jarvik JG, Gold LS, Comstock BA, Heagerty PJ, Rundell SD, Turner JA, Avins AL, Bauer Z, Bresnahan BW, Friedly JL, James K, Kessler L, Nedeljkovic SS, Nerenz DR, Shi X, Sullivan SD, Chan L, Schwalb JM, Deyo RA. Association of early imaging for back pain with clinical outcomes in older adults. JAMA. 2015 Mar 17;313(11):1143-53.

McCullough BJ, Johnson GR, Martin BI, Jarvik JG. Lumbar MR imaging and reporting epidemiology: do epidemiologic data in reports affect clinical management? Radiology. 2012 Mar;262(3):941-6.

 

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