Do You Need an MRI or X-Ray Before Physical Therapy?
The question of whether you need an MRI or an X-ray before physical therapy is a common one. The answer? NO. In the vast majority of cases, you can begin physical therapy without undergoing a diagnostic MRI or an X-ray. Physical therapists can accurately diagnose your condition and address your specific symptoms to relieve pain and restore function without the high costs of imaging testing.
Diagnostic Testing: MRI & X-Rays
An x-ray checks for broken bones and can help a doctor determine the severity of arthritis or osteoporosis. An MRI shows injuries or abnormalities of the joints. If you have had a severe trauma or believe you may have fractured or broken a bone, an x-ray and MRI are certainly warranted. Both of these diagnostic tests provide an internal view of the current state of the tissues in your body. Diagnostic imaging is an impressive medical technological advancement and has its place in healthcare. However, it is limited in correlating the internal view the test provides to the pain you as the patient are experiencing and how to address that pain accurately.
False Positives
A false positive occurs when an imaging test shows that you have a condition or disease when you actually do not have the disease or condition; for example, many individuals who have no neck pain have a “major finding” on an MRI. “Abnormal” findings and impairments are very common on a patient’s MRI or X-ray; these “abnormalities” are often due to the normal aging process of the body. Studies have shown that imaging tests are inconsistent with the presentation of symptoms in both symptomatic and asymptomatic patients. Many symptomatic patients have normal MRI reports, while many asymptomatic patients have “abnormal” reports.
Numerous studies show that imaging tests cannot differentiate between patients who have pain and those who do not:
One study showed that 70% of asymptomatic patients in their 20s had at least one herniation in the neck shown on an MRI, but had no impairments that required action or treatment.
A 2015 review reported that the prevalence of disc degeneration in the spine in asymptomatic people ranged from 37% of twenty-year olds to 96% of eighty-year olds. None of these individuals had symptoms of disc degeneration.
A 2015 study revealed that MRI findings evaluating the necks of 1,211 volunteers showed 87.6% of volunteers had a bulging disk. None of the volunteers reported any pain.
A 2019 study on knee arthritis noted that 43% of those age 40 and older have knee osteoarthritis findings in their MRI, but have no pain.
Diagnostic Imaging Costs
An MRI can be more harmful than beneficial for some conditions. An early MRI can lead to poorer outcomes for patients with low back pain as the early MRI may cause fear-avoidance behavior that intensifies symptoms and delays recovery. Advanced imaging also incurs high costs, adding between $2,500 to $4,800 in medical costs for back and neck pain. These costs result from unnecessary additional testing, prescriptions for medication, injections, lost time at work, and delayed physical therapy treatment.
A 2003 study evaluated the early use of MRIs for those with a new episode of low back pain. One year later, those who had had an MRI were no better in terms of pain and disability and were more likely to need back surgery. A recent study in Health Science Research looked at medical costs for low back pain treatment between physical therapy and MRI testing. The study found that those who saw the doctor for low back pain and underwent an early MRI had higher health care utilization and increased medical costs compared to those who received physical therapy first. Consulting a physical therapist early leads to decreased odds of using diagnostic imaging or future surgery for back pain.
Physical Therapy Treatment
Physical therapists are highly trained medical professionals who provide patients with a thorough orthopedic clinical examination to evaluate the patient’s condition, determine a diagnosis, and design a customized treatment plan to restore function and reduce the patient’s pain. The physical therapist engages in a hands-on assessment in which he evaluates the individual in action, measuring the patient’s range of motion and strength, analyzing the patient’s gait and posture, and assessing current functional mobility. The physical therapist can help determine the correct treatment based on how the patient’s body responds to various tests and measures in real time.
A 2005 JOSPT study compared the agreement between physical therapists and imaging in the diagnosis of a condition. Physical therapists could predict the correct imaging diagnosis 74.5% of the time, which is nearly as accurate as orthopedic surgeons (80.8%) and twice as accurate as general practitioners (35.4%). A physical therapist can accurately diagnosis your condition and provide effective treatment without the need for surgery or prescription opioids.
A physical therapist is trained to screen for signs of any serious pathology that would warrant advanced imaging and testing. A physical therapist continually monitors the medical status of each patient and will refer any “red flag” symptoms to the appropriate doctor for further testing or imaging diagnostics.
In the vast majority of cases, you do not need a MRI or X-ray prior to coming to physical therapy. Your physical therapist is qualified to assess your condition, determine a diagnosis, and create a specialized treatment plan to restore strength, function, and mobility.
