The invention or firstly x-ray imagining and then MRI imaging has led to huge advances in medicine. It’s applications are far ranging and can help guide your physiotherapy treatment. But are there cases where having an x-ray or MRI diagnosis actually be detrimental to your recovery? You may wonder how this could be possible. However, our experience, and new insight into just what pain is suggests this can very much be the case.
In this article we’ll attempt to share with you our experience. Giving you our current understanding of when MRI or X-ray are truly invaluable and when they can potentially be a hinderance. All based on the latest research and what we see clinically here at Brighton Physiotherapy & Sports Therapy.
Why Was X-Ray and MRI Invented?
Human nature drives a lot of our approaches to modern medicine. In many ways this is a good thing. Our desire to understand what is going on. Constantly enquiring just what is the cause? This has led to some incredible technological developments in treatment of conditions and illness. This is not what I want to discuss in this article.
What I want to discuss here is how our desire to know ‘exactly’ what is going on and how that can sometimes become detrimental. In the vast majority of cases it is more important to accept that there are an infinite number of complexities within the human body. And learning when something we find is significant and needs surgical intervention and equally when something is a relatively normal finding and unlikely to the sole cause of you pain.
When Does X-Ray Or MRI Imaging Help A Physiotherapist?
To summarise in a really simple way it’s best use is to check out if anything really bad has happened. Great for if you’ve broken your leg or been in a car crash of course. But also for checking if anything is directly pressing on a nerve close to the spine – nerve root compression. That said it is possible to have nerve root compression and no pain!
More important is the severity of your symptoms and what it is that’s compressing the nerve root. Worryingly one of which can be a cancer growth… but before you go and ring 999 with you will likely have other symptoms like a sudden loss of weight and / or generally feeling unwell. But all the same it is, in many instances, best to check.
More recently MRI has been used to determine the amount of muscle damage that has occurred. This advanced level of assessment is only really available to professional sports people. For those lucky enough to be able to get such scan it can be very useful to help guide any physiotherapy treatment and help predicted return time to high level sport.
When Can X-Ray Or MRI Imaging Be Detrimental?
We’ve spoken about imaging playing a reassuring role. But with musculoskeletal conditions that have been around for a long time its usefulness is less clear cut. Let me try to explain why.
For all but the most serious conditions after 6 weeks physiological healing will be done. This does increase with age but perhaps not as much as you would think. It doesn’t matter how old we are we still have the ability to heal. So if things hurt beyond six week post injury, or there wasn’t even a moment when you got injured, why do we feel pain?
Having a peek ‘inside’ using x-ray or MRI can be appealing at this point. To try to know why something hurts. Unfortunately pain is way more complicated than that as we talk about in detail in our previous article What Is Pain?
When MRI and X-ray scans come back for your average Jo public the words are scary and intimidating. At the clinic we often help people cut through the jargon and help categorise the findings into things they need to be concerned about and finding are quite normal.
Not many people have this translation service available to them however. What can, and frequently does, happen is that we understandably get scared by all these terms which we don’t understand and we get fearful and protective of what we think might be going wrong with our bodies.
Which, according the latest in pain science, actually makes us feel more pain! We often joke that the only thing that makes pain worse is the fear of making things worse. Whilst this is a light hearted quip there is a lot of truth in that statement as backed up by an excellent working definition of pain from renowned pain scientist Professor Lorimer Moseley:
“Pain is an unpleasant conscious experience that emerges from the brain when the sum of all the available information suggests that you need to protect a particular part of your body”
I use the term ‘working definition’ as everyone’s pain is unique. These definitions are based on a lot of research and low level molecular biology but it is very important to acknowledge all of pain is real.
The idea of the fear of making things worse is often referred to as catastrophisation. An excellent piece of research here concludes that people ultimately have less pain without scans and are better off with clinical reporting. Good news for a clinic owner!
All of which put together hopefully show the theory of the pain definition and the idea of catatrophisation is a real thing that really affects our ability to recover. Before moving on I should point it that this was for ‘routine’ low back pain checks. A further piece of research here even suggests that early MRI scans in people with sudden onset back pain are actually out of action longer than those who don’t have a scan! Again those scary nominal findings having an impact on how we hold ourselves and our sensitivity to pain. It is important to note that these were in cases not involving what we call red flags. Red flags are symptoms like issues going to the toilet, a lack of ability to feel the seat on which you are sitting and severe nerve symptoms.
If You Look Hard Enough With MRI You Will Always Find Something
To further the discussion on when MRI and X-ray can be detrimental it’s important to understand we all have anatomical anomalies and imperfections. The vast majority of which do not equal pain. I like to call these anatomical features to make them sound less threatening.
It is these findings, which can happily exist without pain, that can understandably lead to catastrophisation. The table to the left here wonderfully summarises a great piece of research which took a large group of people with no symptoms and scanned them for commonly found issues and degeneration in their body.
One of my favourite lines in this table is that by age forty 68% of us will have disk degeneration. Which sounds just bad! But remember this is in people who have no symptoms. You can see why we like to look at scan findings and reduce our clients’ fears around these less serious findings.
Disc protrusion sounds even worse! A third of us have one, possibly more, without any pain by the time we’re forty. There was a fabulous infographic produced by the British Journal For Sports Medicine which is titled Reframing MRI Abnormalities As A Normal Part Of Ageing. Backing up the point I am trying to make here. I’m not sure what the rules are copyright wise as to whether I can insert it here! So it’s safer for those interested to click the link here to the original Twitter post I found it on.
How Should X-Ray and MRI Be Used With Physiotherapy?
Appropriately is my view. And also the view a consultant radiologist friend of mine I happened to talk to about this article this evening. It was lovely for us to come at things from different angles but to ultimately have a similar conclusion.
What does appropriately mean? Well please do consult your doctor on this but as a rule of thumb if it hurts a lot and either something bad has just happened or you have one of the red flags we mentioned above then imaging is very appropriate.
If your pain is significant please do get it checked out. In the first instance by your doctor to rule anything bad out and then secondly by your caring sharing physiotherapist or sports therapist who’ll always be happy to help. Trust us, if we’re scared by your condition that probably means it’s serious. But for the vast majority it will be a case of reassuring, calming your nervous system down and get on with the job of working out how to work with you to get you feeling better.
If you’d like to speak to us about your condition to see what might be able to be done please fill out the form here and request the therapist call back.