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MRI and Low Back Pain

© Dr. David L. Phillips

Ever since the advent of CT scans and more recently MRI's, I have felt that doctors were reading way too much into what they saw in these miraculous images. Case in point: I am treating a patient who has had significant lower back pain for several months. This painful episode is just the most recent of several bouts going back 5 years. Upon first having pain, this putative patient went to his family physician, who prescribed rest and non-steroidal anti-inflammatory medication, and ordered an MRI and physiotherapy; in other words, the usual stuff. The patient is now into week 4 of pretty bad pain and is fed up, feeling like he's getting nowhere. So he calls me.

The first words I hear from this patient is that he has an MRI scheduled for 3 weeks hence. I listen to his story, examine his back and begin working on him. After 3 weeks, he is considerably better, has returned to work and is beginning to play sports again. He has his MRI and on his next visit, he comes in telling me that his physician doesn't want him seeing me anymore. This surprises me as he is doing so much better with chiropractic care. When I ask why his doctor feels this way, I am told that his MRI revealed several grave findings including disk herniations and spinal stenosis at 2 levels.

I take a deep breath and explain that he has no symptoms or clinical signs of any of these findings. Sometimes wisdom and common sense prevail and the patient stays on to enjoy an even more complete recovery. But sometimes the fear that the M.D. has placed in his mind is too great and this patient stops receiving the very therapy that has given him his life back.

What I have illustrated here is a fictitious case, but one that is all-too-common in chiropractors' offices. Years ago I drew the conclusion that MRI's and CT scans were giving way too many false positive findings, and since then, I have discounted most results I hear that simply don't follow what I see upon examination and hear from the patient's history.

Perhaps you can imagine how gratified I was to read a study that was recently reported in The Back Letter Volume 18, Number 9, 2003. This study looked at just this problem of MRI results that were at odds to clinical findings.

What the authors did was to find 148 men and women who had no back pain. Almost half the group had never had low back problems and the rest had no pain for at least 4 months. They proceeded to examine the entire group with MRI, and guess what? They found a vast number of completely asymptomatic abnormalities. 83% had moderate to severe lumbar disk thinning and disk degeneration problems. 64% were found to have one or more bulging disks. 32% had at least one disk protrusion and 6% had one or more of the dreaded disk extrusions. Remember: NONE had any pain or ANY symptoms of trouble whatsoever.

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