Your MRI is Not Your Story

MRI’s Are Amazing!

Don’t get us wrong, MRI’s help us identify serious problems and can be life saving when used to diagnose and guide surgical interventions. For example, MRI’s help us with…

• Neurological Disorders: MRI is highly effective in imaging the brain and spinal cord, making it invaluable for diagnosing conditions such as brain tumours, multiple sclerosis, strokes, and various neurological disorders.

• Cardiovascular Conditions: Cardiac MRI can provide detailed images of the heart, helping to diagnose heart problems, such as heart muscle damage, congenital heart defects, and vascular diseases.

It’s a tool, and a very good one. However, oftentimes this is mistaken for being able to do everything and solve every problem. Like any tool, if it’s used in the wrong way it can cause harm. Therefore, the purpose of our blog is to highlight some of the issues that can occur with musculoskeletal (MSK) pain and MRI’s and how your MRI is not always your story, particularly when it comes to MSK pain.

A Story We See So Often…

A client is working with us for a month or two and making steady progress but their problem isn’t completely solved yet. We sit down for a session, ready to take the next steps in our plan but then…they show us their MRI results. Often this is accompanied by a look and feeling of dread and despair as we take a look and see what the MRI has shown. Sometimes (but we can’t stress this enough), this is paired with being told by either the individual who performed the MRI, family, friends, or even google, about the horrible outcomes they may be doomed for because of this result.

At the very least, this delays positive outcomes and at the worst can completely derail a positive outcome depending on how well we’re able to navigate that conversation and the level of trust that client has with us. We pride ourselves in being able to navigate these types of situations but the reality is it doesn’t always workout. There are people out there who let an MRI result determine the outcome of their rehab - despite progress being made prior to the finding.

This is what we want to prevent.

Here’s Some Evidence

One study investigated the presence of shoulder abnormalities in overhead athletes using MRI’s. Essentially, they found that although some of the dominant arms did have shoulder abnormalities, this didn’t predict pain, loss of function or need to seek help for issues related to the shoulder. What this means is that sometimes these changes can be normal, present in non-painful shoulders and aren’t necessarily inherently bad.

“Eight of 20 (40%) dominant shoulders had findings consistent with partial- or full-thickness tears of the rotator cuff as compared with none (0%) of the nondominant shoulders. Five of 20 (25%) dominant shoulders had magnetic resonance imaging evidence of Bennett's lesions compared with none (0%) of the nondominant shoulders. None of the athletes interviewed 5 years later had any subjective symptoms or had required any evaluation or treatment for shoulder-related problems during the study period.”

Connor PM, Banks DM, Tyson AB, Coumas JS, D'Alessandro DF. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study.Am J Sports Med. 2003 Sep-Oct;31(5):724-7.

This is not the only example, this is shown time and time again in different areas of the body such as the low back, neck, hips, feet, knees, etc.

Imaging alone is only one piece of the puzzle

MRI scans are an invaluable tool in the realm of medical diagnostics, offering detailed insights into the inner workings of the human body. However, it's crucial to remember that they’re just one piece of the puzzle when it comes to understanding and addressing health issues. While they can reveal structural abnormalities and provide essential information, they don't tell the whole story. The full picture needs to consider a persons medical history, clinical symptoms, physical examination, and even their individual experience of pain and what it means to them. MRI results must be interpreted in context, alongside other clinical data, to arrive at a plan for that person.

Imaging is only a snapshot of your body in time

MRI scans are a powerful tool for capturing detailed images of the body's internal structures, but it's essential to recognize that they provide only a snapshot in time. These images freeze a moment in time, revealing the body's condition at that particular instance. Health and medical conditions are dynamic, with changes occurring over time. An MRI scan may depict structural abnormalities, injuries, or anomalies as they existed during the scan, but they may not reflect how these conditions have evolved or may change in the future. To fully understand a patient's health, medical professionals must consider the clinical history, the progression of symptoms, and the potential for change when interpreting MRI results. This dynamic perspective is crucial for making accurate diagnoses and tailoring effective treatment plans that consider the fluid nature of health and healing.

It Isn’t Designed to Tell Us How We Feel

Pain is Personal and is influenced by so much like your thoughts and beliefs, emotions, memories, your activity levels, loading tolerance and many many other factors. MRI isn't designed to measure your pain directly; it's all about showing us the physical structures and what they currently LOOK like. There’s most likely some errors and this isn’t an exact comparison, but it’s sometimes like looking at the weather…sometimes the weather can be gloomy but you FEEL great.

Let’s Say You Have Something On Your MRI AND You Have Pain, What Do You Do?

1) The number one thing is always to get assessed and rule out sinister pathology by a provider that you trust and who uses an evidence based approach. They can help guide you through a plan and save the guess work associated with doing this entirely on your own.

2) Ensure you’re dosing exercise with advice from that professional that challenges your tolerance level and progresses over time towards your goals.

3) Take advantage of your body’s ability to adapt. The amazing thing about the human body is that it’s so adaptable…people adapt to all kinds of things that happen to their bodies. We’ve seen it SO many times, where people ARE able to overcome MRI findings that seem dooming at the time but end of not limiting them from reaching their goals when approached properly.

Your MRI findings can be part of your story BUT…the rest of your story is yet to be written…