Two questions we get all the time are:

• Do you think I need an MRI?
• Should I wait to start physical therapy until I get an MRI of my low back?

Our first answer: it depends. That answer is not the most helpful, so let’s break it down.

This article,¹ published in 2011, updated the guidelines for primary care physicians regarding the management of low back pain. In this article, they talk about the high cost of imaging and how it rarely helps manage low back pain effectively. Imaging for nonspecific low back pain often led to further unnecessary medical intervention such as injections or surgery.

So, when is an MRI warranted?

Specific low back pain is characterized by symptoms from a specific, identified cause. This may include fractures, infection, rheumatoid arthritis or direct insult to tissue (example: after a car accident or fall). In this case, an MRI may be warranted to rule out certain conditions. Your physical therapist can deduce from an examination if there are any “red flag” symptoms that would warrant a need for an MRI.

These “red flag” symptoms include, but are not limited to:

• Non-mechanical pain (pain is not related to any movement or time of day)
• History of cancer, steroids or HIV
• Unexplained weight loss
• Changes in bowel & bladder habits
• Widespread neurological symptoms
• Structural spinal deformity

For nonspecific low back pain, MRIs are not recommended as the first line of defense. Nonspecific low back pain is defined as “low back pain not attributable to a recognizable, known specific pathology”.² About 90% of low back pain cases are defined as nonspecific and do not warrant an MRI.

In scenarios of nonspecific low back pain, MRIs will not help direct the plan of care or treatment. More and more evidence is suggesting that the best plan of care for nonspecific low back pain is exercise. This should provide immense amounts of confidence and hope for nonspecific low back pain sufferers that surgery is not your only option and there is a light at the end of the tunnel.

So, if I Have Nonspecific Low Back Pain, What Do I Do?

The first thing to do is set up an appointment with a movement expert to receive a full assessment. This will help you get down to the root cause and the “why” of your pain. The information provided will turn your nonspecific low back pain into a specific plan of action. This is exactly what we do at Powered by Movement. At your initial evaluation, your Doctor of Physical Therapy will:

1. Diagnose the root cause of your pain.
2. Create a custom plan with you to get you back to the activities you love.
3. Make a long-term plan of action to get you stronger than ever before and reduce the risk of re-injury.

There is so much information readily available that it is tempting to try to self-treat your symptoms. However, although you may have “nonspecific” low back pain, you still need individualized, specific treatment to get out of pain for the long term. Seeking early physical therapy can help reduce your symptoms quicker and help you gain long term strategies to make sure this pain does not return.

How great would it be to get through one workday without pain? Or to lift as heavy of weights as you want without a shred of fear that it may hurt your low back?

Whatever your goals are, getting to the source of your pain is the first step to making a change and getting back to the activities you love. At Powered by Movement, we help people like you every day. If you are struggling with injury or have a new fitness or performance goal, reach out to us today for a free consultation. Call 314-252-0504 or Contact Us Today for more information on how we can help you live your most active, pain-free life.

References

• Roger Chou, Amir Qaseem, Douglas K. Owens, et al; for the Clinical Guidelines Committee of the American College of Physicians . Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Ann Intern Med.2011;154:181-189. [Epub 1 February 2011]. doi:7326/0003-4819-154-3-201102010-00008
• Non-Specific Low Back Pain Definition: https://www.physio-pedia.com/Non_Specific_Low_Back_Pain.