When one gets hurt or feels pain, they often ask themselves “What is going on?” “Why is my back hurting?” “Did I tear something in my knee?”, questions such as these are common and the curiosity that follows them as well. However, by the time one can see their doctor, get an order for imaging such as a Magnetic Resonance Image (MRI), complete the MRI, have their doctor review the MRI results then meet with the individual to discuss the results, their original symptoms may have already changed or become worse. Often these results will explain the cause of their pain, confirm what already maybe known by the doctor or even reveal another injury that is currently not presenting any signs and symptoms. The next question is “How do I get this fixed?” Doctors often will recommend surgery, anti-inflammatory medication or physical therapy.
According to W. Brinjikji et al pain free individuals will often present with degenerative changes within their spine allowing them to continue their everyday activities unimpeded without the need for imaging or invasive procedures. The researchers of the previously mentioned systematic review have even stated that “Findings such as disk degeneration, facet hypertrophy, and disk protrusion are often interpreted as causes of back pain, triggering both medical and surgical interventions…unsuccessful in alleviating the patient’s symptoms.” (1). Through their research they examined individuals between the ages of 20-80 years, finding that degenerative changes especially within one’s spine is part of the normal aging process (1). They proved this by presenting that >50% of pain free individuals between the ages 30-39 presented with degenerative changes within their spine (1). What this helps to prove is that everyone’s symptoms are different and how we go about in diagnosing and treating should be specific for everyone.
As a patient seeks to find out his or her diagnosis they will often spare no expense often electing for an MRI not realizing that this can prove to be expensive, according to Daoud Makki, MD MRCS, FRCS et al “a thorough clinical examination can be as good if not better than a MRI in diagnosing certain injuries of the knee.” (2). After studying 70 patients who suffered an acute knee injury the authors of this study concluded that clinical examinations predicating ability can be as effective as an MRI scan, after suffering an acute knee injury. They were able to justify this claim by examining clinical variables such as Lachmans test, in being able to correctly diagnosis an ACL tear, the same an MRI.
What does this mean? That even with a positive finding on an MRI result, if an individual is not experiencing pain or hindrance of ability to complete activities of daily living and participation activities, surgery may not be the appropriate remedy. If pain does present itself as well as impedes one’s ability to complete activities of daily living a noninvasive approach like physical therapy can help in addressing this and promote health and wellness long term.
Makki, D., Ness, D., Thonse, R., & Mastan, S. (2018). The Role of Clinical Examination in Predicting Relevant MRI Findings in Acute Knee Injuries: A Retrospective Study. The Journal of Knee Surgery. doi:10.1055/s-0038-1641154
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … Jarvik, J. G. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR. American Journal of Neuroradiology, 36(4), 811–816. http://doi.org/10.3174/ajnr.A4173