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Are MRIs and X-Rays Worth It?

These can be very expensive pictures, but will they give you the answers you need?


An X-Ray often costs around $300. An MRI can range from $700 to $3,000.




So, is it worth it?


Maybe Yes. But, Probably not.


At least for injuries of muscle, tendon, ligament, and bone.


Here’s why. Diagnostic imaging doesn’t give us a clear picture.


No, we aren’t saying the resolution of the images is bad, but the story the images tell might be. Sometimes an injury is not an injury. What looks like a glaring issue on an image might not actually be what’s causing your pain.


Let’s take a disc herniation (disc bulge) as an example.


(Typical process)

You feel back pain and it freaks you out.

You go to your doctor who recommends an MRI.

The MRI shows you have a disc bulge.

You panic because a bulging disc doesn’t sound good.

You get a cortisone shot/surgery/physical therapy with a diagnosis of disc bulge.

Maybe disc bulge-specific treatment works, maybe it doesn’t.

You get a bill for the MRI and all the other treatment in the mail.

The end.


That’s a bummer of a story for you.



But what if the disc bulge wasn’t actually the issue?

(But the MRI showed a disc bulge!)


As it turns out, a LARGE amount of people have disc bulges and have ZERO pain. They don’t even know they have disc bulges!


In fact:


30% of 20 year olds with NO BACK PAIN have disc bulges.

84% of 80 year olds with NO BACK PAIN have disc bulges.

(https://pubmed.ncbi.nlm.nih.gov/25430861/)


So, if all those people can be walking around with disc bulges and not have pain, is it possible that you happen to have a disc bulge which is not the issue and the source of your pain is something else entirely?


Yup.


In fact, sometimes diagnostic imaging muddies the water of a good diagnosis because it causes the medical provider to focus on the wrong issue.


This is not only true for disc bulges in your back.


Similar statistics exist in NON-SYMPTOMATIC (people with NO pain) for:


• Necks: Out of 1,211 people: 87% had disk bulges in their neck

• Rotator Cuff Tears: Out of 52 men: 96% had shoulder abnormalities and 22% had partial rotator cuff tears

• Hip Labral Injuries: Out of 2,114 people: 68% had a labral injury of the hip

Out of 3,110 people: 37% of 20-year-olds had disk degeneration and up to 96% of 80-year-old had disk degeneration.

• Knee Arthritis, and Meniscal Injuries: Out of 5,397 people (over the age of 40): 43% had osteoarthritis, 43% had cartilage defects, and 19% had meniscus tears.




Sometimes the issue in the image isn’t the issue. And even if it is the issue, a good therapist will solve the issue by performing a functional exam.


And here’s the final kicker. EVEN WITH imaging, you’re likely to end up in physical therapy anyway.




Now, I did say that MRIs and X-Rays can occasionally be worth it. In the case of suspected tumors, spinal compression, or other heinous issues, imaging can be a good way to go. Most of the time though, those issues will come with other unresolvable red flags and you/your providers will know imaging is the way to go.


Cut out the middle man (and his $300-$3,000 bill) and go straight to a physical therapist who can analyze your movement and treat the real source of your issue.



Ross Gentry PT, DPT, CSCS, CF-L2



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