MRI makes your low back pain last.... LONGER??

When you have back pain, what's the first thing you want to do? Often, our first action is to get imaging, such as an MRI or XRay. Although MRI seems to be the first response to low back pain, is it really that important? Does it help with diagnosis, treatment, and pain resolution? Or is it actually a hindrance to healing?

An article published in 2021 by Shraim et al. looked at just that.

First of all, why do we care about MRI and low back pain?

The first and most obvious answer is that we want people out of back pain. Most people have low back pain and are looking for answers and help. Our goal is to decrease the length of time in pain, so we look for factors that can speed or slow progress. Of those things, what can we eliminate and what can we focus on? So the question "Does MRI improve low back pain?" is a very important question.

The second answer is not based on the patient as an individual, but the medical system as a whole. Our system is broken and doesn't work very well. Costs are through the roof, so the goal is to be more efficient however possible. Imaging is a big issue - In the US, $100 billion is spent each year on imaging. Granted, imaging for low back pain is probably a small portion of that, but cutting back on the little things can make a huge difference. 

How did the authors complete this study on MRI and low back pain?

The authors completed a systematic review of the literature. This means that they did not complete the assessments, but they searched for high quality, published articles on the topic. They took these articles and determined the answer to that question. Basically, a systematic review is a summary of all qualified research.

The question they asked was: "Does an MRI taken early after acute, occupational, or specific low back pain improve the length of disability?". Put succinctly - "Does MRI improve outcomes of acute low back pain?".

The authors found 354 studies; 7 of these studies answered this exact question with the exact specifications and were used.

 Findings: Does MRI help low back pain?

Here's the answer to the question: Compared to those who did not receive an MRI for low back pain, acute low back pain duration was increased when MRI was completed.

Taking an MRI was correlated to longer duration of pain.

Why does an MRI increase low back pain duration?

While I cannot give a research based, evidence driven answer, I can understand why low back pain increases with MRI completion. These are my thoughts after treating thousands of people with low back pain; not evidence based.

It is a weird phenomenon of the human condition that we like to draw conclusions and assume causations. We absolutely need to know why. Or so we think. Because sometimes there isn't a black and white answer. 

Here's a common scenario. You experience back pain. You have an MRI that shows a disc bulge. Automatically you are convinced that the disc is causing the pain. Therefore, to get out of pain you need to get rid of the disc. That makes you anxious, nervous, and overly cautious because the disc could "slip" or "pop". That mentality will change how movement and exercise are performance. These changes and compensatory movements can increase the risk of injury or pain. You are now in this self-defeating spiral of fear and expectation of pain, prolonging the duration of pain. 

But that might not be true. Maybe that disc bulge has been there for a long time and was an incidental finding. So if the past 5 years with the disc bulge were pain-free, this maybe acute low back pain might not be caused by the disc. The only reason you found out about the disc was an MRI.

So maybe not knowing about every little abnormality in our body is helpful, because there are many other reasons that can contribute to low back pain. The research is strongly suggesting that we might not even be able to diagnose the actual cause; hence, "non-specific low back pain" being a common diagnosis. 

What is the NorCal Physio approach to low back pain?

We attack low back pain in the same method that we attack ankle pain, concussions, and shoulder pain - our 4 step process.

1. Evaluate the condition and create a plan. Effort without a plan is often wasted. Where are you right now and where do you want to go? The answer to that question is the focus of your Physio Eval. 
2. Alleviate the pain. When the body senses pain, it alters how muscles work, how joints move, and how movement is patterned. Ease the pain so you can not only feel better, but also see what is actually happening.
3. Fix the underlying cause. The location of pain is often not the cause of pain. Full resolution can only come when we fix that cause. We now target that cause through corrective exercises, accessory work, and strength training.
4. Build resilience. At this point, pain has resolved and injury has healed. We want to maintain that progress and quickly correct anything that pops up. Long-term, life-long results happen now.

A lot of people are in pain that limits their performance and training, and we don't want you to be one of them. Let's fix your back pain so that you can achieve your dream outcome.

Article Reference:

Shraim, B.A., Shraim, M.A., Ibrahim, A.R. et al. The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis. BMC Musculoskelet Disord 22, 983 (2021). https://doi.org/10.1186/s12891-021-04863-9