Why having an MRI may cause more harm than good

It’s just a scan right? How can it cause harm?….  How can it be ‘Dangerous’?  Isn’t it a GOOD idea to get checked out? 

It might sound a bit extreme right to say an MRI can cause harm or even be dangerous but what we are referring to is the INTERPRETATION of the scan and WHAT THIS LEADS YOU TO BELIEVE as a person suffering and in pain. The “Dangerous” aspect is that it can lead down a slippery slope of failed treatments (injections.. nerve treatments.. medications) and when they all fail it can end with having un-necessary and dangerous spinal surgery.

But as Physios we deal with people in severe back pain often with sciatic type symptoms as well. Often this pain can make them FEEL LIKE SOMETHING IS OUT or as if their back is damaged. These are common things people will express to us. Simply put, we see people who are really worried about what is happening in their back. This concern can often lead the person to push their GP for an MRI scan or they may pursue one privately.

SO, why can an MRI be ‘Dangerous’

Let me play through a  bit of a case study from a few years back to explain this (and this has really happened some of my patients).

Scenario 1 –  Somethings not right – I need an MRI!

Imagine you are this person with severe back pain  (you might be thinking- yep I can imagine that, my back is sore right now!). Imagine genuinely being concerned that your back is damaged and that your pain is related to some form of back injury.

You decide to take the bull by the horns and off you get to Ballykelly to see the pain consultants or orthopaedics who will more than often WANT AN MRI. And this is were the downhill spiral can simply start. But you are simply following their professional advice – nothing wrong with that, if I didn’t know better I would do the same myself. You get the scan and you are waiting to hear the results, you’re a bit nervous  because you are STILL sore. Surely if it was something simple it would have cleared up by now.

Your consultant sits down and shows you that you have “bulging discs” at a couple of levels (often L3/4) but then focuses in on the disc protrusion at L5/S1 which can be seen to “traverse” the left L5/S1 Nerve root. Oh and in addition to this they then tell you (or your read the rest of the report yourself) which tells you ALL the other things that are seen to be “wrong with your spine”  ie. we also saw osteophytes (extra bits of bone) through several levels causing mild foraminal stenosis as well as multi-level lumbar disc degeneration…..

The sinking feeling in your stomach starts as you recognise that this does not sound good. 

In this scenario, at this point, you now advised by professional that YOUR PAIN is related to the “damage/injury” at the L5/S1 Disc (the one that’s protruded and touching a nerve). It “explains” your pain structurally, something is damaged, something is wrong in your body and it will probably need to be “fixed” at some stage.

You are shown the scan and all the rusty damaged bits and you build up a picture of your spine being a bit like the image below, you can see the narrowed discs and the extra bits of bone… it doesn’t look great does it?

Your mentality may start to move towards worrying about hurting that disc further, you don’t want to stick out further do you! You will NATURALLY BE MORE PROTECTIVE OF YOUR BACK – how could you not if this is what you have been led to believe. You may start to be worried about bending or twisting movements that cause pain (because you’ve been told that these movements often make discs worse, or “squeeze the jam out of the donut” or the toothpaste out of the tube).   As you go through a few weeks of being more protective of your back it starts to stiffen and the hold of protective muscle spasm actually starts to become worse and your symptoms deteriorate. This will naturally feed into more fear and anxiety for the future outcome which again a HUGE factor in heightening the severity of the pain you experience (check out our blog on ‘Pain – The snowball effect’ for more on this).  You are probably thinking – that disc is getting worse.

This scenario so often plays out with the person having spinal injections – which either don’t work (and are flaming sore) or very short term ease with a full return of their pain after a week or so. If these fail a consultant may recommend burning the nerve endings in order to stop the pain signal from being sent (in order to relieve your leg pain)… 

AND THROUGHOUT ALL THIS it’s very possible that not one single health professional has even mentioned physio with any confidence.    Ok so you can see that this scenario has not played out well but this really DOES HAPPEN!

To find out what you should do you could request one of our Free Physio Taster Sessions to help get some advice about how you should manage your pain.

Scenario 2 – The happy ending

Lets start again.

Imagine you are this person with severe back pain  (we’re back at the start again, you haven’t got a scan). Remember… you are genuinely concerned that your back is damaged and that your pain is related to some form of back injury but you’re not sure what to do or who to see.

You decide to take the bull by the horns and a family member recommends the super friendly and wonderful physios at Causeway Physio & Pilates (please excuse the shameless plug 😉).

You come in, nervous about the assessment, nervous about what can and can’t be done. The physio performed a gentle assessment to look at your back and hip movements, they check how the nerves are moving. They double checked reflexes to re-assure there was no major nerve compressions and they helped were able to reproduce a bit of your pain by performing a few specific movements of your lower back and legs.

They then took time to explain HOW nerves can become sensitive and painful but when you start to do the right things to help them they will start to settle, become less painful AND eventually as you progress your movement and rehabilitation the nerves will become completely painfree again. The physio is realistic with you, they tell you that it will take a number of weeks to get good reduction in your pain and even longer before you feel 100% but they explained why this is a gradual recovery rather than a miraculous instant one.

You asked the big question “Do I need to get an MRI?” and the physio tells you that at this stage there is absolutely no need for an MRI as they expect your symptoms to recover well over the next 4-8 weeks. They did reassure me though that if we worked on providing a good opportunity for the nerves to settle yet the pain wasn’t improving then at that stage they would certainly refer me for an MRI.  They told me that people WITHOUT back pain actually have disc bulges and disc protrusions and that I don’t need to have a “perfect” or “structurally normal” spine, I just need to get the bits that I have USED TO NORMAL movements…   

As someone who was really concerned about what was happening inside your back, this advice that you didn’t need to have a perfect spine and that the body can fully resolve from these types of injuries sounded great and really helped you feel like you were going to get through this!

With being reassured that certain movements (even though they are a bit uncomfortable to do) are actually going to help your nerves and lower back become less painful with movement, you start easing your way into them and after 1-2 weeks you are really starting to feel you are moving the right direction. Your pain is still there but it is much less and you are starting to feel like you want to get out for a nice walk again AND you are being advised to do this, to get gradually more and more active! 

The physio continues to reassure you that you don’t need an MRI scan because your body is RECOVERING! They continued to remind you and give examples of great recoveries about how our bodies don’t need to be structurally perfect on MRI scan in order to have less or no pain BUT we do have to ensure we help sore areas become less pain sensitive and GIVE THEM AN ENVIRONMENT TO HEAL. They told me that just resting and time off work isn’t going to help your nerve pain fully recovery and that you need to gradually get the back and nerves used to more and more movements that they need to be exposed to.

You’re now 4 weeks in, your pain has reduced by 60% and you are walking, swimming and planning a phased return to work with clear guidance from your physio. From this point you are so pleased to know your body is recovering and the physio has told you that they will help to progress the exercises to a level where my back is even much stronger than it was before the injury!

LOVE IT! – They happy ending.

So this may seem like a made up scenario but this is true.  This happens. In fact, it happened to one of our patients. Check out Lynne’s lifechanging transformation from severe sciatica and back pain – being virtually housebound due to pain AND awaiting spinal surgery – to achieving a FULL recovery, feeling fitter and stronger than she has in years! We share Lynne’s story in our Relieve Back Pain & Sciatica Guide – click below to find out more.