Tests and Diagnosis
Imaging — Do You Really Need an MRI?
The Natural Desire for an MRI
When pain persists, it's perfectly natural to want an MRI to "find the cause." However, MRI is not a magic answer. Imaging at the wrong time can actually cause more harm than good.
How an MRI Can Be Harmful
Research has shown (Srinivas 2012, Jenkins 2018):
- It can create unnecessary anxiety — Many "abnormalities" found on MRI are normal age-related changes (explained in "Why Does Your Back Hurt?")
- It can lead to unnecessary further tests — Once an "abnormality" is found, more tests tend to follow
- It can lead to unnecessary surgery — Surgery based on MRI "findings" that aren't actually causing your pain may not help
- It can make you feel "broken" — Seeing structural changes on a scan can make you believe your spine is damaged, when it may simply be aging normally
A Reminder About "Normal" MRI Findings
| Age | Changes Found on MRI in People With No Pain |
|---|---|
| 60s | 88% have disc degeneration, 69% have disc bulging |
| 70s | 93% have disc degeneration, 77% have disc bulging |
| 80s | 96% have disc degeneration, 84% have disc bulging |
These numbers are from healthy people with no back pain at all. (Brinjikji 2015)
In other words, being told "your disc is degenerated" or "you have a bulging disc" does not necessarily mean that's what's causing your pain.
When an MRI Is Appropriate
So when is an MRI truly warranted?
| MRI Is Indicated | MRI Is Likely Unnecessary |
|---|---|
| Progressive leg weakness | Back pain under 6 weeks with no red flags |
| Suspected cauda equina syndrome | Chronic back pain without neurological symptoms |
| Suspicion of cancer or infection | "Just to be safe" or "for peace of mind" |
| Planning surgery or targeted injections | When a recent MRI from another facility already exists |
The Problem of Both Over-Testing and Under-Testing
A revealing study found (Jenkins 2018):
- 34.8% of imaging requests were inappropriate — ordered despite the absence of red flags
- Meanwhile, 65.6% of patients who did have red flags were not imaged
The problem is not just too many tests — it's that tests are being done on the wrong patients: those who don't need them get scanned, while those who do need them are missed.