Man with low back pain in gym. Sports exercising injury

Do I Need an MRI of My Low Back Pain?

Well, no, is the short answer.

Here I discuss non-specific low back pain (LBP) which may or may not be accompanied with sciatica, from no known cause i.e. no major trauma has occured.

The research

'Findings' seen on an MRI scan do not correlate with the pain experienced. Meaning, pain does not equal tissue damage and apparent damage does not equal pain.

You can scan any one of us and 97% of the time an 'anomaly' will be found, yet we do not experience pain from it. An anomaly would include disc bulges, facet joint wear and tear, nerve encroachment and many more. These are all normal findings, especially as we age.

The important points to know:

  • Research shows that findings on an MRI scan of your spine does not correlate with the pain you have.
  • Less than 1% of findings equate to pain arising from serious pathology
  • Less than 5-10% of all low back pain is due to a specific underlying spinal pathology
  • The remaining 90-95% has no indication of a serious cause and should be managed with conservative treatments such as advice and reassurance, exercise, physical therapy, manual therapy, cognitive-behavioural therapy, or pain management.
  • Additionally, research has found that MRI findings cannot predict that pain that you will have in the future.

In fact, having an MRI can be damaging in a psychological kind of way - knowing you have, for example, 'degenerative discs' may stop you from doing the things you love through fear avoidance behaviour. It can create and amplify pain.

We can safely say, then, that MRI should not be recommended when the all too-common-simple LBP is present.

Photo of the back of a female with a fern in line with her spine

Diagnosing Pain

Diagnostic triage is based on clinical history and examination. This information distinguishes between non-specific or more serious low back pain

This means that practitioners like myself (osteopaths), physiotherapists and chiropractors are trained to diagnose and treat musculoskeletal pain. We can conclude from taking a thorough case history and examination, that your pain is not from a serious source.

We will ask questions to rule out 'red-flags' to ensure you are safe to treat, to ensure your pain is mechanical in nature. 

LBP is common and it will and can go away with the right advice, care and attention. Episodes can go away by themselves within 6 weeks.

Imaging may do more harm than good

Disc and spinal joint abnormalities  are commonly seen on images but may not be the source of pain, as they are also seen on images in up to 97% of asymptomatic patients.

Knowing you have a non-painful disc bulge for example, may make you think you shouldn't move a certain way; you may avoid exercise. This is not healthy.

Findings from an MRI make no difference to the treatment planned, and they might even slow accessing therpay down. We are best to start giving pain relief and exercise advice ASAP.

Female sitting on her bed holding her lower back because it's painful
More Facts

Less than 1% of findings equate to pain arising from serious pathology including fracture, inflammatory disorders, infection, malignancy, cauda equina syndrome (serious compression of the nerves supplying the bladder and bowel)

Low back pain with or without sciatica can be debilitating and exhausting. It is regularly stated in research that 80% of the population world wide will suffer with LBP in their life time. It has a huge impact on our economy (time off work) and drains our precious NHS resources.

What Can We Do About It?

NICE recommends considering manual therapy, including spinal manipulation (we osteopaths are skilled at this), for the management of low back pain with or without sciatica. This MUST be coupled with exercise advice and of course reassurance.

CBT and pain management is also advised for those that have chronic pain (>12 weeks). Understanding your pain is paramount to healing.

Exercise advice might include specific exercises to mobilise and stretch your back, mindfulness, Pilates – whatever you’re going to enjoy. Movement is key. Bed rest is not helpful.

Your GP might recommend taking a short course of NSAIDs, you should talk to them about this option before taking any yourself as they come with potential side effects.

Why am I in Pain?

Pain cannot be seen on an MRI scan because pain is way more than just a structural cause, if indeed at all. So, what causes pain?

Pain is an experience and it is unique to each of us. It normally arises in the tissues as they become hypersensitive to perhaps mechanical stresses. But there's normally lots of other things going on, too. 

Factors impacting pain:

  • lack of sleep

  • stress

  • previous experiences of pain/injury

  • beliefs and expectations

  • lack of exercise

  • emotional wellbeing

By improving any of these will likely help your pain.

Linda teaching the Cobra in Pilates class
Osteopath treating the lumbar spine

How I can Help You

One of the reasons I became a Pilates teacher is to keep people off my treatment table, and it works. I'd always recommend Pilates because of this.

Pilates might not be your bag. Simply moving more, in whatever modality you enjoy is going so be good for your physical and mental health.

I am here for you too, as an Osteopath (manual therapist) to help manage your pain. My treatment must, then, do just that – relieve pain.

Reassurance is often the most beneficial part of the session. The relief folks feel when they understand nothing serious is going on is palpable.

Plus of course, we need to eat well, move more and sleep well.


References:

Amanda M Hall, Kris Aubrey-Bassler, Bradley Thorne et al. Do not routinely offer imaging for uncomplicated low back pain. BMJ. 2021; 372: n291. Published online 2021 Feb 12. doi: 10.1136/bmj.n291

Kasch, Richard MDa; Truthmann, Julia PhDb; Hancock, Mark J. PhDc et al. Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Spine: 47(3):p 201-211, February 01, 2022. | DOI: 10.1097/BRS.0000000000004198

Juichi Tonosu, Hiroyuki Oka et al. The associations between magnetic resonance imaging findings and low back pain: A 10-year longitudinal analysis. PLoS One. 2017; 12(11): e0188057.

Published online 2017 Nov 15. doi: 10.1371/journal.pone.0188057

Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173

NICE Guideline (NG59), Low back pain and sciatica in over 16s: assessment and management. Nov 2016