MRI for back pain – does the report content affect the management?

MRI for back pain

Does epidemiologic data affect how one treats painful discomfort? The authors of a recent study asked this question and hoped to determine whether the results of a magnetic resonance imaging test could affect how problems are treated. The conclusion was that a patient was less likely to include a prescription for narcotics to care for symptoms when such information included an MRI scan and the imaging reports.

Why would doctors treat differently based on the imaging reports? Seeking an MRI scan for back pain isn’t an automatic choice but a smart one; according to the American College of Physicians, such imaging is used for patients who experience lower back pain as well as symptoms that seem to suggest other underlying problems. For others, it seems that having routing imaging isn’t associated with significant benefits — in actuality, harm could come of it.

Looking into the inefficiency of this form of testing is vital to preventing harm and will impact how resources are used, both in the direct and downstream costs alike. At least in this aspect, further testing does not mean getting better care. By being more selective with imaging the back, better care can be provided while getting better results and spending less.

Another immediate issue to look for is that an MRI scan may show structural changes that are mistakenly believed to be causing the back pain. Following with that line of thought, the doctor and patient can both believe that the structure should be changed or will remove the tissue, which will therefore change the pain. While surgery can be a perfectly reasonable means of intervention for relief, it is not always the answer.

Adding information about the common findings of body scans in those without symptoms seems to be delivering a powerful message about the journey of the patient. At the core, this is what must be changed — the condition of the body must be better treated, along with the experience of the affected individual.

With this message, we are beginning to normalize. The main point to take back here is that the body and spine may change over time, but it is not necessarily causing a problem. A person who sits in the clinic likely has a problem that needs treatment, but this is not necessarily the work of an MRI scan. If one has been taken and shows that there is no serious problem, then great — still, many feel anxious and uncertain when there is no visible evidence explaining their agony. This makes perfect sense as the problem was not identified with the scan. In their mind, the scan had no meaning. This likely leads to further discomfort.

Now we must consider what we already know about the body and pain. Describing the mechanisms of pain and the biology that dictates it involves quite a number of systems in the body, as well as additional factors for pain like prior experience, stress, fatigue, movement, anxiety, perspective of the situation, as well as numerous other factors. All of this is biological, whether it’s a thought, an action or an emotion — it’s biologically rooted in the body. It is possible to use different dimensions of pain to construct a program that affects both the pain and all factors influencing it.

Having done this, it is next important to come up with an individual program to offer specific training that the individual needs to get the body doing what it’s used to doing. This does not include a scan but includes other techniques to improve awareness and body confidence, both of which are vital.

Finally, the individual should be monitored throughout the period, noting changes in function or pain under the right conditions. This helps us determine the next best course of action.

The debate on MRIs and whether one requires an MRI will continue, which is good; it is important to always question what we know so we can provide the best treatment for the individual patient.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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