What are the hidden risks of relying on back MRIs?

If you’ve ever suffered from acute or chronic back pain, or perhaps you’re suffering from it right now, you’ve probably longed to “look inside” to find out what’s going on. You’re not alone. Many people share this desire, and most doctors agree with this approach.

But what if I told you that getting a back MRI too soon could lead to more injections, procedures, and even more (often unnecessary) surgeries? What if I told you that 80% of all types of back pain, even debilitating sciatica, can be resolved naturally?

It’s not just my opinion. Research shows that getting an MRI for back pain too soon can lead to more invasive treatments (like injections, procedures, or surgeries) that can do more harm than good in the long run. Additionally, relying on MRI results alone to determine a treatment plan often steers people away from natural, noninvasive treatments that could effectively manage, or even resolve, pain in the long term rather than the short term.

What the research says

A 2023 study published in The Journal of Orthopaedic Research found that patients who received early MRIs within the first six weeks of back pain, without any warning symptoms, were significantly more likely to undergo surgical procedures and use opioid medications.

These patients also reported worse pain outcomes and a higher incidence of disability at one-year follow-up compared with those who delayed imaging. This growing body of evidence suggests that premature MRI scans not only lead to more aggressive treatments, but also contribute to a more negative outlook on recovery, potentially worsening overall outcomes.

So when is an MRI necessary?

An MRI is essential when alarming symptoms, often referred to as “red flags,” are present. These include signs of cancer, infection, inflammatory disease, possible fractures, or serious neurological deficits. Healthcare professionals, including physical therapy specialists, are trained to identify these warning signs, but it is important to note that they occur in only 5-10% of all back pain cases.

To put this in perspective, in my two decades of treating patients with back pain, only three had symptoms this severe. In that case, I knew I had to refer them immediately for an MRI. Now, I don’t say this to minimize the severity of back pain, but to emphasize that most people don’t need a back MRI to receive an accurate diagnosis and effective treatment.

If you undergo an MRI without a clear need, you are at higher risk of undergoing unnecessary procedures or surgeries and a greater chance of being prescribed opioids, neither of which have great long-term results compared to a natural treatment approach.

Let me explain to you

When you get an MRI of your back, the problem is that it reveals everything: bulging disks, arthritis, stenosis, and degenerative disks — all common findings and a normal part of aging (although doctors don’t always tell you that). After a certain age — usually between 45 and 50 — these conditions are present in almost everyone, regardless of whether they have back pain.

Research backs this up. For example, a 2015 study by Brinjikji et al. found that 50% of people between the ages of 40 and 60 had bulging discs and 88% of people between the ages of 60 and 69 had disc degeneration—and none of them suffered from back pain. Because these findings have not been effectively normalized, they are often wrongly blamed for back pain when seen on an MRI. Why? Because most people only get an MRI when they have back pain.

However, research like this shows that you can’t reliably correlate MRI findings with the actual cause of pain. A growing body of research suggests that people with and without back pain can have almost identical MRI results. As Dr Martin Underwood, co-author of the Lancet series and a professor at Warwick Medical School, said: “If you start treating disc degeneration just because it shows up on an MRI, the chances are that for most people it’s not contributing to their back pain at all.”

Feeling confused? You’re not alone

The reality is that 70-80% of all back problems, including sciatica, are “mechanical” in nature, meaning that your pain will fluctuate (you will have good days and bad days) and that movement can either provide relief or make your condition worse.

Frustrating, right? Or maybe you find it comforting because this sounds exactly like what you’re experiencing?

Mechanical back pain, however, cannot be accurately diagnosed with an MRI. Instead, it is accurately identified through specialized repetitive motion testing (performed by a mechanical pain specialist) to determine what triggers and relieves the pain. From there, corrective movement strategies can be prescribed to eliminate the pain and prevent it from returning.

While this approach may take longer, it offers far better long-term results than any procedure or surgery. If you undergo an MRI for what is likely mechanical pain, you risk receiving unnecessary treatments that could worsen your condition. It is important to remember that back surgery is irreversible and complications from surgery can be difficult to manage. It is your duty to explore all conservative treatment options first.

If you are currently suffering from back pain or sciatica (or have suffered from this condition for years), I understand how frustrating it can be. Consider seeing a mechanical back pain specialist who can help you identify the true cause of your back pain and address it with corrective movement strategies rather than relying on an MRI. Give yourself the opportunity to resolve your back pain naturally, without resorting to invasive procedures or surgeries.

Dr. Carrie Jose, a physical therapist and mechanical pain expert, is the owner of CJ Physical Therapy & Pilates in Portsmouth, NH and writes for the Seacoast Media Group. To get in touch or request a spot at her next masterclass, “End Back Pain Naturally, Without Procedures or Surgery,” visit www.cjphysicaltherapy.com or call 603-380-7902.

This article originally appeared in the Portsmouth Herald: Health & Wellness Carrie Jose Hidden risks of relying on back MRIs