Don’t Marry Your Diagnosis!
I heard this phrase quite often throughout my chiropractic education, and as I am coming to find, with good reason. As a chiropractor I frequently encounter many back pain sufferers who are told they have “bulging discs” or a “disc protrusion”, for which they are told to learn to live with the pain. Most of these people walk around thinking there is nothing they can do for their pain, after all an MRI showed bulging discs or even worse degenerative disc disease.It makes sense, you have back pain and you have a MRI showing an abnormality, so naturally we connect the two and assume the abnormality found on MRI is causing the pain. However, that would be wrong.
A research study done by the department of orthopedic surgery at George Washington University found about 1/3 of people who NEVER EXPERIENCED BACK PAIN, displayed a “substantial abnormality” on a low back MRI. A similar study from Hoag Memorial Hospital also performed a low back MRI on people who were experiencing NO PAIN, but they found only 36% of those people displayed “normal discs at all levels”
MRI is extremely sensitive and is capable of detecting even minor abnormalities. However, not all of those abn
ormalities are of consequence. Recently, prominent sports medicine orthopedist Dr. James Andrews noted the misleading nature of MRI. In a recent New York Times article he reports finding abnormal shoulder cartilage or rotator cuff tendons in 90% pitchers who WERE NOT INJURED AND DID NOT HAVE SHOULDER PAIN.
Another study from The Spine Journal concluded that
“…Among workers with LBP, early MRI is not associated with better
health outcomes and is associated with increased likelihood of
disability and its duration. These associations warrant further
testing in a randomized controlled trial. Our findings suggest that
adherence to evidence-based guidelines is an important factor in
ensuring that workers receive the highest quality care for
occupational injuries.” (Emphasis mine)
MRI is used in a wide variety of conditions from pain to tumors. I am in no way suggesting that MRI is useless. MRI certainly does a phenomenal job of pinpointing abnormalities. However, we must remember, correlation is not causation. You may have back pain and you may have an abnormality on an MRI, BUT the abnormality is not necessarily causing your pain.