Is Your MRI or X-Ray Misleading You? 

Is Your MRI or X-Ray Misleading You? 

This is an excerpt from Dr. Andrew Gorecki's very popular book, The Truth about Lower Back Pain. To get your FREE copy visit: https://www.lowbackbook.com/ 

I want to make it known that to fix lower back pain and find a real permanent solution, an MRI or an X-Ray is not necessary.    

In fact, I would argue that these images can actually make outcomes worse for the patient.   

I see people on a daily basis who feel that they need an X-Ray or an MRI to show their healthcare providers exactly what is going on.   

The problem with that thought process is that regardless of if you have stenosis, a disc bulge, SI pain (which typically doesn’t show up on an MRI or an x-ray) the idea that an MRI or an X-Ray is going to help the provider fix your lower back pain is false.   

The reason for that is because all three of those lower back conditions ultimately are a result of a bigger problem.  That bigger problem is what is actually causing damage to the lower back.  

I like to use the analogy of an iceberg…   

What you see above the water is only 10% and below the water is the other 90%.   

It is not the lower back’s fault that it has a disc herniation or SI inflammation or stenosis. It is the areas around the lower back that ultimately aren’t moving properly that are causing stress.   

All lower back pain is ultimately a result of damaged tissue in response to stress.  

So yes, an MRI or an x-ray helps identify which type of damage you might have, but it doesn’t help you find the treatment that will stop the stress and stop the damage.   

In my opinion, and what I tell many patients that I see, is that an X-Ray or an MRI should be used as a pre-surgical tool.  If all else fails, a surgeon needs to have an MRI or an X-Ray to determine what part of the spine he/she is going to surgically alter.   

As you noticed, I didn’t use the word fix because I think the word fix is a relative term.  Any and all lower back surgeries don’t fix the problem.  They just alter the problem.   

Let me share a story of a patient I recently had the opportunity to work with…   

He was a local physician who had developed severe sciatica and lower back pain on the right side of his body.  He was hardly able to walk.  He happened to see our advertisement in the local paper for a Lower Back Pain and Sciatica Workshop. 

After the workshop, he came up to me and told his story…   

He had recently gone to his primary care physician who offered him pain medications for his symptoms, but he was struggling because legally he can’t take pain medications during his work hours.  He had also just gotten an MRI, which showed he had a disc bulge on the left side of his spine.  He then consulted with a neurosurgeon who recommended he have surgery immediately.  In fact, he was actually scheduled for surgery the following week.   

His question was… How could a disc bulge on the left side of his spine cause pain down his right leg and in his right lower back?   

The answer I had for him was… it CAN’T.   

He was almost relieved with that answer.  Being a physician, he was almost embarrassed that he didn’t know the answer or believe the neurosurgeon, but deep down inside, he knew that it was not possible and that it didn’t feel right to have surgery.   

So, he committed to 15 visits of physical therapy and every visit he began standing up straighter, walking without pain and finally was (and still is) pain free.   

His big limitation was actually his hip mobility, which was causing increased stress in his lower back.  His disc bulge had nothing to do with his problem.   

If you remember back to chapter 2… looking at the statistics and the research behind MRIs specifically for disc herniations, what they show is that 60% of people that are given an MRI for any reason will have a disc bulge or disc herniation. But only 10% of those people have pain.   

Basically, what that means is that the MRI often times can actually confuse the provider and make somebody think that they have a disc herniation or a disc bulge, when ultimately the pain is not coming from that abnormality.  

We also know that there is a huge cost with MRIs.  The average MRI is over $2,000 and they are only typically valid for less than a year.   

They really just don’t help as much as we think they help.  I would even argue that there are health providers (such as Physical Therapists, Orthopedic Surgeons and Physiatrists) that know what are called orthopedic special tests, which are movements or positions n which you put a person to identify what is their actual problem. And research has shown a high level of reliability that these tests can indicate what the source of the lower back pain is or the type of lower back pain that somebody has.   

For instance, if I have somebody who I believe has stenosis in the lower back I can give them a verbal questionnaire which has been proven to be 97% accurate.   

The questionnaire asks:   

#1.  Are you over the age of 55?  

#2.  Do you have lower back pain upon standing and walking?   

#3.  Does your lower back pain go away with sitting?   

If you answer yes to all three of these questions, then there is a 97% chance that you have lumbar stenosis.   

That has been proven by research and is actually more accurate than an MRI or an X-Ray.   

We also know that testing for disc herniations and disc bulges would include a test called a Straight Leg Raise or a Dural Stretch Test which stretches the sciatic nerve.   

If that is a positive test, there is a 90% chance that the person has a disc herniation or a disc bulge.  

The self-test can be found online at http://thesuperiortherapy.com/category/video-learning/self-tests/  

We also know that just asking the patient, “Do you have increased pain down your leg with coughing, laughing or sneezing?”  Those are very strong indicators that a person has a disc herniation or a disc bulge and is much more accurate than an MRI.   

I often have patients who come in with imaging…   

They tell me their symptoms and their symptoms don’t fit with the image they have in their hand.   

You have to disregard the X-Ray and the MRI, which becomes a waste of money and a waste of time.   

Being confident that research shows that the image may not be true is very important.  Trust me, I have seen this happen hundreds and hundreds of times in the past. Yet, every patient that comes in the door feels that they need to have that image.   

So, I'm here to tell you that the MRI and the X-Ray often times are lying to you.   

It is not the most accurate way to identify lower back pain and find solutions.   

In fact, it doesn’t help anybody find a solution.  It just helps you categorize an individual and tell them what the structural damage is… But it does not tell somebody what to do about it, what the cause is, or what the treatment should be.   

It is ultimately a tool that should be used only when somebody is about to have surgery so that the surgeon knows the exact level to go to when he/she is going to alter the structure of the lower back.   

I think that it is important to understand that MRIs and X-Rays have a purpose, but it is not the purpose that you probably believe.   

I'm here to tell you that you should trust the health provider that you are working with and if they don’t feel that you need an MRI or an X-Ray, then that should be the advice that you follow.   

Otherwise, you could end up spending way more money and way more time than you really should be in the first place.  And ultimately it just categorizes you and it does not find a permanent solution.