MRIS LEAD TO MISDIAGNOSIS AND OVER TREATMENT

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MRIS LEAD TO MISDIAGNOSIS AND OVER TREATMENT
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Magnetic resonance imaging (MRI) allows us to see
a clear image of soft tissues and deep structures
inside our bodies. They can create
high-resolution images of the entire
musculoskeletal structures, including bones,
tendons, muscles, ligaments, and nerves. MRIs are
valuable as they show details when there are red
flags. But MRIs also show natural changes due
to aging, and they cannot decipher painful from
non-painful structures. Too often, misdiagnoses
are made based on such findings, and the actual
cause of pain is overlooked. MRIs lead to
misdiagnosis and over treatment. When used
correctly, MRIs are an important tool, but they
are overused and have lead to over-medicalization.
  If you take a picture of the inner mechanics
of your cell phone it may show water damage,
etc., but only by using your phone can you tell
if it actually works. An MRI takes a great
picture, but only by moving and using your
muscles and joints can you tell if they are
painful and function correctly.
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The use of MRIs in the US continues to grow at an
alarming rate despite evidence that improved
patient outcomes do not accompany it.
Overutilization of imaging in individuals
with low back pain has been correlated with a 2-
to 3-fold increase in surgical rates over the
last ten years and probably the same with other
joints not yet studied. MRIs act like a sales
funnel. Being told that something is wrong causes
anxiety and fear. You then seek treatment as you
search for a fix. MRIs are harming many by
causing fear and often a misdiagnosis, both
leading to unnecessary treatments and a higher
rate of chronicity. If MRIs Show a Clear Picture
of Underlying Structures How can They Lead
to Misdiagnosis and OverTreatment? Research has
shown that 43 of isolated extremity symptoms
originate in the spine. If you have pain in your
shoulder, elbow, wrist, hip, knee, ankle, etc.,
there is a high likelihood that your symptoms
actually come from a problem in your spine.
Getting an MRI of your painful joint will likely
uncover natural age-related changes and, 43 of
the time, not the actual cause of pain. Instead,
a problem where the pain is located will be
unearthed and falsely confirmed as your
diagnosis.
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Age-related changes are part of the natural
process, like wrinkles on your face and gray
hair, and do not cause pain. Signs of
degeneration are present in very high percentages
of healthy people with no problem. Asymptomatic
20-year-olds have a 37 chance of degenerative
disc disease and a 30 chance of disc bulge. Many
imaging-based degenerative features are likely
part of normal aging and are not a cause of
pain. Disc degeneration, bulging, and even
herniations are often found in those with no back
pain.  Cancer, infection, and problems within
your internal organs often refer pain to the
spine. An MRI is performed where the symptoms are
located will more than likely show changes, and
the true cause of the problem will be
overlooked.   Mechanical Assessment Instead of
an MRI for Precise Diagnosis  Rather than a
costly MRI, a simple Mechanical Assessment should
be performed to uncover the underlying cause of
pain.    
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A mechanical assessment identifies problems
within your musculoskeletal system by the affect
of movement on your muscles and joints and if
there is a change in your symptoms. This starts
by first ruling out your spine, no matter where
your symptoms are located even for pain in your
toes. You simply move the spine to see if it
affects your symptoms. After the spine is ruled
out, the clinician will assess the muscle and
joints around where your pain is located.
Musculoskeletal problems are mechanical in nature
and must be aggravated or relieved with
movement.If positions or movements do not affect
the symptoms, then testing for non-mechanical
such referred symptoms from internal organs or
cancer must be investigated. Medical guidelines
strongly discourage using MRI and X-rays in
diagnosing low back pain because they produce
many false alarms. Over fifteen years ago, the
American College of Physicians and the American
Pain Society strongly recommended against imaging
for managing low back pain without suspicion of
underlying serious pathology (e.g., cancer,
infection, or fracture). Their 2007 guidelines
for the management of low back pain. recommendatio
ns
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InsteadGet up and MOVE! Walking and moving are
the best thing you can do for posterior
herniations as walking places a slight anterior
force on the herniation pushing it back in the
center direction. It is essential to minimize
your sitting and maintain activity within your
threshold. Research has shown that those that
continue to work within their tolerance have
faster recovery than those that stay home from
work. They take on a passive patient
role. Research has shown that the more involved
you are with your care, the better the outcome.
Healing is an active, not a passive process. Most
current protocols for treating back pain and
herniations are passive, including medication,
massage, injections, TENS, surgeryall of these
have not shown any benefit. Instead, they create
a patient role. The more passive care you
receive, the longer you suffer and the higher
rate of chronicity and disability. Instead,
become empowered. Learn what position/activities
caused your herniation and what you can do to
avoid them as well as heal. Remember to Mistakes
to AVOID with a Herniated Disc
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Clinicians should not routinely obtain imaging or
other diagnostic tests in patients with
nonspecific low back pain  Clinicians should
perform diagnostic imaging and testing for
patients with low back pain when severe or
progressive neurologic deficits are present or
when serious underlying conditions are suspected
based on history and physical examination      MRI
s are a gateway to Surgery and Increase
Healthcare Spend! When you are in pain, you want
to know what is wrong, and every patient wants an
MRI because they believe it will clearly show the
underlying problem.Almost 25 of those with low
back pain will still receive imaging, even though
it is not following current guidelines.  Imaging
improves patient satisfaction, but numerous
studies have shown that improper use of MRIs is
also associated with misdiagnosis, poorer patient
outcomes (persistent pain and chronicity),
increased downstream healthcare utilization
(increased back surgeries, opioids, injections,
treatments), and increased healthcare
costs (1, 2,3,4,5,6,7)       
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MRIs often Cause Fear and Lead to Chronic
Pain. The knowledge that an abnormality is found
would cause anyone to feel that something is
wrong, and they will do whatever is needed to fix
it. Hence the increase in treatments, injections,
and surgery linked to those that have received
MRIs. Not only do MRIs increased healthcare
utilization, but they also install fear. Fear
leads to avoidance behavior and is the oxygen to
chronic pain. When you are scared of causing more
pain, you stop moving and lack of movement leads
to unhealthy stagnation and initiates the chronic
pain cycle. An MRI must be used wisely, and the
patient is educated on the findings and rates of
natural aging to decrease their fear.  MRIs have
a vital role, but they must only be used with
wisdom after a thorough mechanical assessment
and red flags are found. Are MRIs Reliable? We
naturally assume that MRI is a reliable
technology, but they are just a picture that can
have a shadow and require education and
experience to interpret correctly. Researchers
had a 63 yo volunteered go to 10 different MRI
centers in a short period to compare the
interpretations from different MRIs and
radiologists. The researchers determined that
each radiologist made numerous errors. 49
distinct findings were gathered, and not one was
found in all reports -adding a question to the
reliability of the testing we hold as a gold
standard.
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The most common reason to obtain an MRI is for
low back pain, and a common abnormality found is
spinal stenosis. Researchers sought to find
if radiographic findings would match clinical
findings for stenosis. Radiologic and clinical
impressions did not correlate. The MRI could not
determine if spinal stenosis is a cause of
pain. MRIs are a powerful tool and can clearly
show spinal canal narrowing, the basis of
diagnosing spinal stenosis with MRI. It questions
then the assumption a narrowed spinal canal alone
can cause back pain. Another researcher
performed MRIs on those with no low back pain and
then a repeat MRI if a patient did develop an
episode. 84 of those that developed pain had
unchanged or actual improved imaging after their
pain developed. 90 of the initial MRIs showed
significant negative findings, even though they
had no low back pain and included 50 had either
disc protrusion or extrusion, nearly 30 had
annular fissures 2 potential root irritation.
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Many have positive MRI findings even though they
have no pain, so instead of being a positive
finding they should be notes as natural
changes. MRIs Must Come with Education Our
bodies have an amazing way of healing. For
instance, 67 of disc herniations spontaneously
reabsorb, and the larger they are, the more
likely they are to be reabsorbed. Patients are
not provided education or explained that some MRI
findings are part of natural aging or that
degenerative changes found might be meaningless.
Our bloodwork comes with ranges. MRIs should also
come with notes about the percent of natural
degenerative changes seen in asymptomatic
individuals as we age. Instead, MRIs often lead
to additional tests, follow-ups, and referrals
and are a gateway to invasive procedures of
questionable benefit.
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VPTs clinicians know that it is challenging to
counteract negative consequences following an
imaging finding of degenerative disc disease,
herniated disc, rotator cuff tear, or arthritis,
to name a few. A patient will typically focus on
this adverse finding as to the source of the
problem and feel that they are broken until
surgery can fix it. In reality, these findings
often have nothing to do with the pain they are
experiencing, and instead, these changes were
there long before the symptoms appeared. It takes
a long time after the patient is symptom-free to
convince them they are ok despite their
MRI.  Degenerative changes are often a natural
part of aging, like wrinkles and gray hair, and
do not cause pain.
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Virtual physical therapists

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