Updated: Oct 20, 2021
This is a common question we get from patients searching for care. We are going to break down what the MRI is really telling us and the dreaded surgery question.
Magnetic Resonance Imaging (MRI) was created to look inside the body in a way that an X-ray cannot. It shows all of the soft tissue structures: discs, organs, ligaments etc.. It was developed with the intent of helping doctors become more accurate at diagnosing and providing treatment. Although a great tool in the medical field, it has lead to an over utilization of MRI and poorly done exams by physicians. Physicians are taught to perform a thorough exam and have a diagnosis determined BEFORE they order any type of imaging. Unfortunately, this does not always happen.
Lets turn our focus to what the MRI is actually telling us, that way we get a better understanding on the relevance of its findings.
To take an MRI we need to lay flat on a table motionless while the machine produces an image.
It may show multiple tissue abnormalities: tears, inflammation etc.. Then, whatever findings are present, the doctor will make a diagnosis.
That diagnosis is then assumed to be responsible for the symptoms you are experiencing.
The information from the image is used to determine your treatment options.
The question is are we treating the person or the image?
Research disagrees with the use of MRI's for musculoskeletal pain prior to an in depth physical exam.
You may ask why is that? The study, "Magnetic resonance imaging of the lumbar spine in people without back pain" by M C Jensen1, M N Brant-Zawadzki, N Obuchowski, M T Modic, D Malkasian, J S Ross, looked at 98 people without back pain and performed MRI's on all of them. 64% (63/98 people) had disc bulges reported on their image.
This tells us people will have MRI findings whether they are experiencing symptoms or not. We cannot rightfully say off the image alone that the disc bulge is causing your pain.
Taking a detailed patient history and assessing movements and symptom responses is still the best way to determine the type of treatment that is necessary. The human body is a large system of multiple muscles, nerves, ligaments, organs, joints, and bones compiled together to perform functional activities. Thus, a full body movement assessment will tell us a lot more about what the patient is experiencing versus a rudimentary image.
You may be asking yourself why do we even use MRI for musculoskeletal conditions then?
If a severe trauma has occurred to the soft tissue structures of the body (ligaments, nerves, muscles) it is crucial to take an MRI and determine what tissues were damaged. This helps the surgeon have an idea of what he/she may need to do.
When a trial of conservative care has finished (Physical Therapy or Chiropractic), and no positive change in the dysfunction or symptoms have occurred, then it is considered a responsible time to perform and MRI. At this point in care it is safe to say that the condition may not be purely mechanical based and/or treatable with manual therapy.
It is important to understand we are not saying MRI's are useless, but rather a tool that is over utilized for the wrong reasons, but when used for the right reasons can be life changing.
Do you need surgery for your disc bulge/herniation? The answer is....it depends. I know it is not the precise answer you were looking for, but hopefully below we can put your mind at ease and help you understand what we mean.
What qualifies a disc bulge/ herniation to require surgical intervention?
If you are experiencing severe symptoms such as: complete muscle weakness, muscle atrophy, sensation loss, difficulties using the bathroom or not going at all.
Complete loss of reflexes or hyper spastic reflexes (clonus).
These are main signs and symptoms that directly need surgical intervention.
These are serious symptoms that may indicate cord compression and could potentially put your life at risk.
What qualifies a disc bulge/herniation for conservative treatment?
You may have minor muscle weakness when tested with resistance, normal to diminished reflexes, and hypo-sensitivity.
You may experience spinal pain that is local, accompanied with tingling/numbness sensation that radiates into your arms or legs.
Altered posture may be present, you may be shifted forward or to the side to avoid causing more pain.
You are able to use the bathroom with no problems, but it may be difficult to walk/move because of the pain.
If you are still struggling to find answers for your disc bulge/herniation contact us at Peak Performance Chiropractic and Rehab. Dr. Logan Georgeson is highly skilled at assessing and treating disc bulge/herniation injuries using the McKenzie method (MDT). The combination of specific exercises and movement education will have you feeling better, moving better, and living your life again.
Remember, the internet is a great place for information, but it does not replace an exam from a thoroughly trained healthcare professional. If you are suffering from pain, or need help reaching your health goals, feel free to contact us!