Do I Need An MRI To See A PT?

Hi, I'm Dr. Molly with Your Goals Physical Therapy. Let's talk about whether or not you need to have an MRI before you come into physical therapy. In my opinion, the answer is no. And here's why, so first the difference between physical therapy and a surgeon? So surgeons and, your primary care physician, they use x-rays and MRIs to diagnose structural issues. I mean, I would use it for the same thing, I'm gonna look at the picture and know, okay, this is where some injury has occurred. And, you can make a plan accordingly. Especially, if I was going to go in as a surgeon, then I would need to know exactly what it is that I'm going to be doing surgery on and what it looks like. So I can come up with a game plan. It would be very important for me to at least have a general idea of what I'm going to go in and see.  And if things change, once you open somebody up and things change, but at least you had a general idea going in. ​

Now in my world. What I've seen are things like this. So if I take two examples, I received MRI reports from two different patients. It was actually the same week. So the first MRI was of a gentleman who used to clean the inside of cars. He did detail work for cars, and he had a 10 centimeter disc bulge; which doesn't mean anything to anybody. And it barely means anything to me, to be honest with you. But 10 centimeters is huge. Normally bulges are measured in millimeters. So, that was a big difference in fact, that was so dramatic that I even called the doctor to find out if I was reading that correctly, or maybe that was a typo. It was a very large disc bulge that they found in this poor gentleman who at the time was in his early thirties. I'm expecting to see somebody very devastated when he comes in. Now let's compare that to the second MRI that I'm talking about now. And that MRI, it was a very minor disc bulge and per the report. It wasn't encroaching on any nerves. And so it's, and it really wasn't very big at all. So nobody was really expecting there to be a whole lot of dysfunction related to the disc bulge.
 
But when they came in, I got very different stories.  

The gentlemen barely noticed his discomfort. It just got really sore at the end of his day, and he was more annoyed by it than anything else. So that was a very different presentation. I was able to work with him on breathing techniques and stretching and working on some core stability and changing how he was moving in his environment to completely eliminate his pain. And it wasn't very long when he was in therapy because he didn't have a lot of pain and he was able to do everything he wanted to do, so off he went.  

Now this other woman who based on the MRI report only had a very small disc bulge. She came in, she's like hunched over, she couldn't handle deep breathing cause it just set her lower back off. She had to have medication for muscle relaxers and a lot of medications for her pain. She wasn't able to tolerate much of anything because anything that moved her lower back, it just inflamed and irritated everything. She ended up having to have surgery based on all of her symptoms. 

And so that's why MRI reports in where I'm at are not necessarily the end all be all. I really do have to take a look at the person that's coming in and where your symptoms are, what happens when we bend this way? What happens when we bend that way? Does this make this better? Does it make it worse? What does it look like when you're moving around dynamically? What does it look like when you're sitting in a chair? What office activities bother you? What household activities bother you? So let's work through that. If we do X, Y, and Z, does it make it better?  If we do X, Y, and Z, does it make it worse? 

So that way we can make everything as stable as it needs to be so that you can get back to all of your favorite activities. The MRI is a great supplement for me, but it's definitely not something that is going to be a huge lead because your symptoms are going to be the big thing that I follow. So I hope that that kind of answers the whole, do I need an MRI for physical therapy?

Hope you're having a good day. Bye.

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