In the office we are commonly asked about MRIs, when should we get one? TV hospital shows make it sound like everything needs an MRI first before any treatment should begin. Not to mention, my friend said he got one when his back hurt.
I am not against MRIs, but they are a tool. Every tool should be used appropriately and efficiently. I also like value and hate waste. I know my jeep leaks oil by seeing the oil spot in my drive way, and checking the dip stick reveals I'm about a quart low. Why would I bring my car into a dealer to have them check the oil and say, "The car is seven years old and shows the usual signs of wear and tear, and add 1.17895 quarts. Your bill is $750."
Call me old fashioned but I know the jeep has some wear and tear because I know exactly what I did to it. I can also add a quart of oil and then recheck. If it needs a little more I am capable of adding a little more oil until it is right.
This scenario happens every day with MRIs. A lot of great information can be gained from a quality back exam. If the exam and the office testing show signs of sprains, and do not suggest anything big, bad, or nasty, then an MRI isn't necessary. There is a 95% chance that it won't show anything that would change our treatment plan.
If all your history, exam findings, and testing suggest a moderate or severe low back sprain then we are going to treat you for a severe low back sprain. We won't do anything that could aggravate a disc problem just to be safe.
A little secret in life is that a treatment plan for a severe low back sprain or disc herniation (bulge) without positive orthopedic exam findings are almost identical the first two weeks. A sprain will act like a sprain and start to get better with treatment. A disc bulge is just starting to show itself but will start acting like a disc problem over the next two weeks. If we don't see improvement like a sprain should then let's get the MRI.
It most cases we have the pain 30-50% improved before we would ever get the MRI result back. Not to mention you didn't have to lay on your back for 45 minutes in the MRI unit or pay for a test that didn't provide you any benefit.
After explaining the exam findings to a patient and the rationale for waiting on an MRI for two weeks, he made a simple comment: "So you're saying if it talks like a duck, walks like a duck, and acts like a duck then let's treat it like a duck. If it starts acting like a bad duck or something else, then we get the MRI."
For more information on Low Back and Sciatica click here.
Disc herniations information can be found on the lumbar disc decompression page.