As humans when something is wrong we try to problem-solve to fix whatever the issue may be. First, we must identify the source of the problem so that we can address the root cause to lessen or hopefully get rid of whatever the issue is. This is true even when it comes to figuring out why we get pain in our own bodies. Let’s take back pain, one of the most common areas of musculoskeletal (muscle, bone, joint) pain, for example. When someone tweaks their back (maybe from moving something heavy) or has had chronic back pain for years that just won’t go away, either way, we want to find out why we are having pain. Why? Because pain can limit us in our daily activities and stop us from enjoying things we love to do. So how do we identify the source of pain in our body? One of the first things that may be done when going to see a physician is imaging (x-rays, CT scans, MRIs). This sounds like a reasonable approach as it can see what inside the body looks like at that moment in time. However, what if I were to tell you that what is found on imaging many times may not actually show what is causing your pain. Many people know someone or may have even been told themselves that they are having back pain because they have a “bulging disc”, “degenerating discs”, or maybe a “herniated disc.” Although this is what is seen on the image there has been research studies showing that people with these exact same imaging findings have no pain at all. Yes, on their MRIs they have disc bulges, herniations, and degeneration with zero pain!
So what does this mean?
Hear me out, I am not saying imaging should never be used. It is extremely useful in certain instances. For example, when there is obvious trauma to the body (motor vehicle accident, contact sports injury, fall) imaging is needed to determine if there are bone fractures that typically require casting or splinting to heal. Other times imaging is needed, is when tumors may be suspected, or for testing of organs/blood vessels. However, for pinpointing musculoskeletal pain (especially back pain) imaging should not be the stand alone determinant of your diagnosis or pain. The musculoskeletal system is a dynamic system that moves, bends, twists, turns, tightens, and loosens depending on the demands we put on our body to complete tasks. With that in mind we therefore must take each person’s personal circumstances into perspective. This includes their current activity level, nutrition, sleep, job, and stress levels just to name a few as all these factors play a role in our body and recovery. From a physical therapy perspective, we specifically look at motor control, strength, mobility, and overall body mechanics of movements. As a Physical Therapist, if we find deficits in any of these areas, we directly address them through manual therapy techniques, neuromuscular retraining, and through specific exercises. When these are addressed, it allows you to use your body how it is intended to be used. In the process, pain relief occurs because you are no longer compensating with improper mechanics to perform movements.
Bottom Line: Do NOT rely only on MRIs, X-rays, and CT scans to tell you why you are having musculoskeletal pain. Talk to your Physical Therapist to get a full musculoskeletal examination and evaluation to figure out the root cause and address it right away. Bonus: It’ll save you a lot of money…MRIs aren’t cheap!
-Dr. Arron Pierce PT, DPT