MRI Scans: The Good, Bad & Ugly

"I cried when they told me"

This was how a Pilates class member responded when she learned that her MRI scan showed osteoarthritis in her spine. 

MRI scans are a fantastic medical tool, but they also have a dark side and their limits.

Here's the good, bad and ugly sides of MRI scans:

The Good

• Can detect very small changes in bones and soft tissue
• Good for finding pathology (injury or disease)

The Bad:

• Very poor association with pain - changes seen on MRI scans don't correlate well with the level of pain or disability actually felt by the patient
• Can't tell you when the changes started or how long they've been present

The Ugly

• Patients with chronic pain who've had an MRI scan have been shown to have worse long-term outcomes and more disability compared with those who haven't had a scan.

Do any of these surprise you?

My Pilates class member was certainly surprised to hear that MRI scans don't correlate well with pain, or that they can't tell you the timeline of the changes seen.

When should you ask for an MRI scan?

• If you've had an accident or traumatic incident leading to acute pain and potential injury. For example, a fall, trip, sports injury (eg, football tackle / skiing fall), road traffic accident etc.
• An unexplained, sudden onset or severe pain
• If you have a new back pain, and one or more of the red flags for spinal pain (see below)

BEWARE!

• MRI scans are an extremely sensitive medical instrument, and excellent at finding even tiny changes in bones and soft tissues,. These changes are sometimes labelled as pathology, like my Pilates member who was told that she had arthritis in her spine.
• Most people will have bony and soft tissue changes detectable on an MRI scan starting from their 20's. Many of these people are NOT in pain and are symptom-free. Check out these MRI scan results of people with no symptoms and who aren't in pain:

W. Brinjikji, P.H. Luetmer et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015 April ; 36(4): 811 – 816. doi:10.3174/ajnr.A4173.

• There's a large body of evidence showing that pathological changes on MRI scans are very poorly associated with the amount of pain and disability actually felt by the patient. Some people with minor changes experience severe pain, whereas people who have zero pain can have severe pathology on scans. 
• There's evidence that being told the results of an MRI scan can prolong a patient's pain and increase their level of disability post-scan. This might be a nocebo effect (the opposite to the better known placebo effect), where what you believe becomes your reality.

Takeaway

MRI scans are an important medical tool for detecting traumatic injury.

They're less successful or necessary when dealing with a chronic pain that's been present for 6 months or more, especially if this pain came on gradually or is unlikely to have been a result of an accident, fall or trip.

If you do decide to have an MRI scan, it's important to avoid attaching your pain to the results of the scan. 

PATHOLOGY DOES NOT AUTOMATICALLY RESULT IN PAIN!

It's possible that the changes seen on your scan images may have been present long before the scan was done., and before the pain started.

Believing that your scan results are causing the pain you feel is more likely to prolong the pain, and reduce your willingness to stay active. Being sedentary is a far bigger risk to your health and mobility!

NEXT STEPS

• Get my expert insights on a specific injury or pain that you're struggling with in a 15 mins call that will help you move forwards to recovery. Complete the interest form HERE
• Book into a Stretch or Pilates class with me - these are a good introduction to The BYB Method for pain relief.
• Come to a pop-up class - a different theme each month, open to everyone, run at a peaceful retreat venue, small group. See the class schedule HERE
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

If you would like help with managing pain or a particular injury please reach out to me on any of these channels:

• Email at norma@unicornhealthandfitness.com
• DM me on Facebook Messenger 
• WhatsApp message to 07801 867361.