Do I need an MRI for lower back pain? True or False

Do I need an MRI for lower back pain is a common question that is asked when a patient has a first episode of pain or a reoccurrence of lower back pain. Most people believe when they have severe pain that immediate MRI or even an x-ray is the key to understanding the problem. It is looked upon as the essential component to start treatment. Let’s first understand what an MRI is and specifically when we are talking about lower back pain or pain in and around the lumbar region. Anyone who specializes in treating people with lower back pain realizes a proper diagnosis and treatment are comprised of three basic elements.
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First, a thorough Medical history from the patient which includes when it started, help begin with the trauma or gradually, have you received treatment before, is the pain constant or intermittent, and other medical conditions that the patient has been diagnosed. Second, during a clinical exam which includes checking the patient’s range of motion, strength, sensation, deep tendon reflexes, gait, and functional movements. Lastly, physical therapists or a doctor decides if further testing is necessary, which can include an imaging such as an MRI, x-ray, nerve conduction testing and blood work. As a physical therapist the history of the problem is often the most critical piece of the puzzle. A tremendous amount of valuable information is contained in the history. Also like the patient, is their body better than anyone to best possible treatment solutions. A famous quote is “Just listen to your patient, he is telling you the diagnosis”.
What is an MRI?
Magnetic resonance imaging is a noninvasive diagnostic tool that uses radio waves and a magnetic field to produce detailed images of the inside of a body. Doctors can use them to examine a person’s lower spine, or lumbar region, and the surrounding tissues. It can detect inflammation, disc bulges and disc herniations, thickening of ligaments, arthritis, and pinched nerve, loss of water content, degenerative changes, tumor and prep for surgery or an injection.
Is it safe?
The good news the MRI is generally safe in most cases but each patient must be properly screened for the following: metal implants, pregnancy, and allergic reactions in the past to certain dyes used in MRI imaging. As compared to CAT Scans and X-rays the MRI scan does not utilize radiation as part of the testing.
When do you decide if an MRI is necessary before you start physical therapy?
Whether it is to a doctor or physical therapist. If the patient mentions any “red flags” which come up when speaking to the patient during the history portion of the evaluation the patient is then directed to get blood work, EMG, x-rays or MRI before physical therapy can start. The following is a short list of red flags:
Low Back Pain starting at the same time as developing a fever, Severe Night pain that does not vary with time of day or position, Bowel and Bladder Changes that coincided with the development of low back pain, Severe progressive weakness in the lower extremities, Balance Problems
If you experience any of these changes an MRI may be ordered and/or a referral to a specialist. If none these red flags are present you than can proceed with care. If an MRI is ordered without the previous red flags it is non-essential for a few reasons. First and foremost many back problems resolve without any form of care in 2-3 months no matter how severe the episode may be. Also, it has been noted when people receive an MRI in the first few weeks most times the findings show many abnormalities that may have been present prior to this episode of pain. Unfortunately, MRIs show a variety of changes in your lumbar spine that are simple part of aging but may not be the “pain generators” for your recent episode. Worst of all the findings the MRI reports make patients more fearful about causing further harm and they often take longer to recover because of avoiding various forms of movement. My general recommendations is too slowly increase your activities and an working through mild lower back pain that resolves with a few hours is nothing to avoid and should allow your body to heal more rapidly. An expectation of being completely pain free as you return to activities will result in deconditioning and more time away from things you enjoy.
Additional studies have shown there is not an increased risk if an MRI is not performed initially by a physician or a physical therapist that are trained to screen for red flags. Both physical therapists and physicians can detect a need to refer out if concerned about a serious medical condition.
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[@adamsolorzano7821]

The information was really helpful thankyou

[@bellasantos6332]

Thank you for your help.

[@apexmovebetter]

Your welcome!

[@sernani99]

Great explanation, I have back pain for more than a decade now, last time the flare up put me on the floor for 3 days, another 2 days on bed since I tried to get up and couldn't at the 6th day I use a Walkerto walk in order to hold me up. Also it feels like someone got a piece of rebar and got it piping hot and stab me and moving it around. I feel pain on muscle, tail bone and spine, it's hard to bent back up after washing my face and brushing my teeth. My doctor only gives me tramadol, cyclobenzapar(mispronounce) methocarban, meloxicam etc. I finally ask for a mri, with all this going on on my back, would you advise me to go ahead and have done? Thank you.

[@entertainment-rl2su]

I have back pain in upper right side...due to which I feel shortness of breath .. please suggest me should I go for MRI or not.. or anything else?

[@Em6726]

Why do doctors push muscle relaxers and physical therapy on people who are experiencing recurring waist pain instead of seeing what an mri has to show. Let’s get to the bottom of this should be the order of the day.

[@nicoleflores2294]

Exactly! Currently fighting with my insurance over this! My Doctor ordered the mri for me and my insurance is denying it! Even after I appealed it!

[@kitten1122]

dealing with this as well. ive been in pain since my childhood, PT told me to use a cane but I can barely walk! 20 years they've been playing these games with me, I'm ready to give up and get euthanized in Belgium

[@Zaidzookhan]

You people dont know how sensitive is this test! N how dangerous it is :)

[@Lela70]

@@nicoleflores2294My insurance denied me too, and in their denial letter they said that I needed 6 weeks of physical therapy and no improvement on pain. I had already done six weeks of PT. WTH?

[@DreamerRhodes]

​@@Zaidzookhan MRI are not dangerous your confusing it with a ct scan

[@kingdru_562]

Recently hurt back bending over. Doctors said I strained my back muscles. I'm seeing a Chiropractor and may get sore and stiff after workouts but no real pain or discomfort unless I sit for too long. Also if I stand for too long a slow pain starts to radiate through right hip and intensifies the longer I stand. Cat Cow stretching will stop it instantly. Still working on forward range of motion but struggling with that out of fear of re-injuring back. Any feedback???

[@RashadSims-bh3zz]

Can u get an x ray as well?

[@bellasantos6332]

Hi I have surgery done.i was doing good.but after 12 Years over night start the pain againg.in the morning when I woke up the start again.the pain goes away and come back..I don't know if the mattress.or what.day time I feel fine.what can be .do I need Marl.

[@TashaHarrisTashaluvsyou]

Thank you

[@apexmovebetter]

Your welcome

[@Realtalks45]

I got pain in my lower back ( one side ) during long jump which kind of injury could it be plz reply

[@theamericanpatriot87]

I injured my low back about 13 years ago doing heavy squats. On the way up, out of nowhere my back just gave out and I felt extreme pain. Fell flat on the ground. Had to be carried out. To this day my low back still really bugs me and the pain has been getting worse and worse lately. I've seen two different doctors over the years who chose not to do any scans or imagery. Just prescribed muscle relaxers which did nothing. I know it's not a muscle issue. What's your advice? Thanks.

[@apexmovebetter]

I would see a physical therapist and see where you stand with movement patterns, range of motion and strength. Lets get you back to doing the things you want to do and more comfortable. Good luck but don't give up on lifting heavy and pain free.

[@nathalielopez7920]

Dude omg I think I hurt myself lifting as well, the pain was so bad. Dr ordered an X-ray turns out I had a slipped disc & a fracture! Def push for imaging

[@madanpalsingh1162]

Hello sir, sir please suggest me some best strengthening exercise of Quads. I need so much sir please tell me.. Please reply..

[@justzo8252]

so I was injured at work and it hurts on my sides of my rib cages when I want to sleep on my side. It hurts when I take a step, it’s like theirs pulses of pain shooting up my spine telling me to stop walking because there’s something wrong. It hurts aswell around my hip area which just recently started and it also hurts when I try and squat down,bend over or even arch back. So far no medication has been able to calm it down for a long period of time but one thing that does relax me is breathing exercises. So please get back to me with some tips or some info on what you think of my situation. Thank you 😊

[@apexmovebetter]

Look at my video titled McKenzie exercises for low back pain and sciatica.

[@apexmovebetter]

That a a video on box or square breathing.

[@apexmovebetter]

Tell us how you do!

[@vonadd9253]

question, I fall down 6 times, on my back, different occasions, and was having back pain from the first fall, 2019 at work, run out of the rain, I was out for a few seconds, the second time I fall down so hard on my hip at home, was also in 2019, 2020, I fall down from stairs at home rushing to go to work on my back, the third time, I fall from a chair at work 2020, forth I fall down at home , I trip over board, and fall on my right side and back 2021, fifth time, I fell down, on a pavement on my back and right side 2022 April, I fell down 2022 June of this year. now I can hardly sleep at night for discomfort of lower back pains on my rightside, I when to the doctor for every fall, but I have a nagging pain inside of my back, my right leg is numb all the time, I was having problems passing stool, I some time don't stool for more than a week, but when I do, it hard to pass, and every time, it hurts because it's comes out hard most of the time, one time I was at the doctor and he told me the x-ray I had done shows I have alot of stool in me, now recently the x-ray show again in have alot of stool in me. I don't know what causing the pain, but my clinic schedule is a month away, for me to see a orthopedic, I was at the emergency, but the doctor told me I have to see orthopedic, but I was given muscle relaxer and pain killer and that is not working for me, oh and 2003 I had a C-section surgery and when the surgery was over, 6 doctors came to my bed and said, them might of made a mistake on me, because when they started the surgery, they started with 24 instruments, but when they was done, they only could fine 23 instruments, they look under the table, in garage, every where but the couldn't find 1 of the instrument, and it could be in me, I was kept in hospital for 1 month for observations, when I was released, my lower stomach started swelling and turning dark in color, I went to the hospital and the same doctor who did the surgery was call to check me out, a new doctor who was just transferred there, checked me and send me for as ultrasound and it's show the I had a leaking of fluid and they don't know where it's coming from, I was told that I have to go back into surgery, but I didn't,because if they made a mistake before, they might kill me, and I didn't return, because I was scared. with that be said, I am expecting numbness in my foot, and lower back pain, I need to know what going on.

[@berenisse1000]

A chiropractor I injured me the right side from middle to the end of my back, only right side, for 5 mi the iwas in ed most of the time, I was full of spasms on that area, then got an electric massage that helped me to walk again, my dr said it was going to take time, now after 10 months the pain remains here, goes on and off some days pain free but always come back, I went to the orthopedic he doesn't want an MRI even tho this is not going away, I'm so sad because I can't stand for more than 40 min on my feet and I feel like my right side sacrum is popping out FT trying to help, but for God's I want to know what this chiropractor did and for long I'm staying like this😭😭😭

[@apexmovebetter]

I would get another opinion from a physical therapist or doctor

[@kaitlynvieth7802]

I have a history of back pain. I was told I have scoliosis but I am in so much pain I have to go to the emergency room sometimes.. to me it feels muscular or like nerves. Definitely muscle spasms. I have had xrays but no one has suggested an mri. They gave me exercises to do at home and I feel they don't take me seriously

[@apexmovebetter]

It can hard because back pain is so common. But it can really impact your life. Ask for a physical therapy evaluation if you don’t have success. If you’re in New Jersey you can contact me I got a life evaluation

[@eddiegonzalez5070]

Get an MRI! Just to be safe

[@tinaquinn9689]

I have always had back pain mornings now at the minute I'm in agonizing lower back right leg and buttocks it's can't even stand straight or lay in bed going on now 14days. I'm getting MRI on Friday I'm very scared in case it'something bad .bowel and passing urine is fine

[@apexmovebetter]

That is early on in your recovery. It doesn’t necessarily mean it requires injections or surgery. Just wait to review with doctor before you worry

[@kcet1948]

Don't forget aging is catching up. Takes time to heal. Go hang upside down like a bat.

[@bossmikemotovlog4459]

I have cronic cervical radiculopathy and lumbar radiculopathy, do i need to do test of MRI?

[@apexmovebetter]

I would get an evaluation by a PT or an orthopedist to determine the best course of action. It depends on a few factors.

[@JeriellWayne]

2yrs ago I fell on the roof and my lower back hurts until now. the left side of my back really hurts. do i need mri? my age now is 16 my last checked up said my lower back part have small crack

[@apexmovebetter]

I would seek a physical therapy evaluation. I’m not sure if they meant fracture or tear.

[@vannmalaythong1900]

What if you get lower back pain every several months it last for about a week or 2 , several month it comes back should I get an mri , I got an appointment next week

[@apexmovebetter]

If you haven’t had formal care I would start with a physical therapy evaluation. Sounds like a mechanical back problem that Would probably benefit from some papa strengthening or range of motion exercises

[@111himanshurana9]

What was the result

[@user-xz8gj1dn6m]

From somebody that knows... I've had lower 3 lumbar discs herniated 13 times now in NZ and it's actually genuinely more often due to your line of work,COVID came and there was a computer hack on national news so I only personally have the last 5 years of records...osteopathy, physiotherapy etc etc red flags as said in the vid 👍 are unable but always been recommended first,it's incredibly frustrating reducing your day to day life without any action. Well today was my first MRI scan,dead nerve,lowest disc is non existent and next 2 are on the verge. I don't go saying I'm tough or any of that stuff but omg I spent days crawling and it's savagely painfully for anybody that knows. Does anybody else have a similar stuff I'm only wondering for myself coz why do health systems have to be so bad that now your only seen terribly as such and can no longer do what you know/skill base rather than treatment first and continue??!! It's crazily frustrating and total feeling of uselessness without ability to change,wrong outlet I guess hey 😅 but it needs to be said coz now im looking at fusion etc and entire lifestyle change when i feel like i could still contribute so much earlier ahhh its shit hope whoever else has read this is better off and achieiving their goals for sure 🤦🤦🤞🤙

[@apexmovebetter]

Best of luck! Hope you get some relief!

[@kinleyware]

I have been having this leg pain in my left calf muscle or bone or nerve which I am not sure of as the pain gets intense at times and is mainly on the inside with burning sensation with mild pain and discomfort on my left lower back . I did two ultrasound of my limb that ruled out DVT and one of my abdomen that ruled out kidney or any problems related to organs. So I was wondering if MRI could detect anything as I have seen three Doctors now and they are not sure of what is causing it. To share my history of pain, I noticed a mild pain on my left calf muscle when I starting running at the start of February 2020 followed by heavy physical work, especially lifting for two solid months and then intermittent lifting till the end of August 2020. I would really appreciate if you could give some suggestions. I am having severe pain in my leg and burning sensation on my left oblique that sometimes extends down to my glutes and back as I write this.

[@apexmovebetter]

You probably need a good physical therapy evaluation. An MRI will not show a loss of motion or strength deficit that may be contributing to the problem. You probably need a good evaluation from Mackenzie certified therapist

[@nathalielopez7920]

Hi there ! I woke up one morning with extreme lower back pain … brought me to my knees. I saw my primary care doctor she said it was a pulled muscle, months went on and though the pain got better, it never fully healed. She sent me to do X-rays and now the X-rays show a compression fracture along with 1mm retrolisthesis and disc space narrowing . So now she wants to do an mri. Would you say an MRI is essential in my case

[@apexmovebetter]

Might shed some light on soft tissue structures. Just to clarify do you have any pain, weakness below the lower back?

[@nathalielopez7920]

@@apexmovebetter no weakness

[@apexmovebetter]

I would lean to an MRI but more importantly a spine specialist to see what the origin of the pain. The question is the compression fracture the origin of the pain. It is good you don’t have weakness but you should get a evaluation. Most primary doctors are not trained in this type of problem. Good luck and keep me posted on your next step for care

[@nathalielopez7920]

@@apexmovebetter I set up the appt for the MRI it’s on Monday And I saw the sports medicine dr yesterday . She said the pain seems to be from my L5 which is the bulging disc so she wants to do the mri and to include the compression fracture in there as well

[@abrahamjoseph276]

I have suffering back pain over 7 years until now not relief i make MRI but the doctor said the bones is good but i still have the pain so what can i do again 🙏😔

[@kcet1948]

Apply ice pack and alternate with jacuzzi at the gym.

[@user-lm6fl2wq8g]

Hello, i have a question. If i go in for an MRI lambar spine without contrast.. will the show inmages of my brian or scan my brain or take any picture of my brain, or have anything to do with my brain? Or since its for lambar spine, will they only focuse on that and other parts of my body? I have high anxiety cause i dont want my brain involved. I have lower back pain that fluctuates, and when it's cold, i feel it down my left leg. . thanks so much. I hope to hear back from you soon?

[@apexmovebetter]

They shouldn’t

[@user-lm6fl2wq8g]

@apexmovebetter Thank you so much. I got Mt results I have 3 herniated disc :( I hope it's curable

[@apexmovebetter]

An MRI is important when it is for the right patient. Many people believe an MRI is essential to get better. It is part of a whole picture. My mantra is "you can't treat an MRI!". Please submit any questions you may have! #MRI#lowbackpain#herniateddisc#bulgingdisc#physicaltherapy

[@dnegel9546]

I've been to 2 different doctors for my lower back pain. (I hurt myself doing heavy squats.) They always go straight to x-rays and Everytime they say my spine is perfect condition. After this they sort of just blow me off and act like I'm making it up. They send me to therapy or a chiropractor. Which does absolutely nothing. What can I do for these doctors to give me an MRI??? I literally feel like I'm going to fall apart.

[@apexmovebetter]

@@dnegel9546 you really need to find a PT who specializes is sports rehab and issues around Olympic or power lifting. Stuart McGill has a great series of books on back treatment and evaluation of athletes. I would start there. Is it an insurance limitation?

[@dnegel9546]

@@apexmovebetter no I don't think it's an insurance limitation. I just got out the E.R. and they did the same thing x-rays came back good and they gave pain meds/muscle relaxers. Yet I can barely sit or stand or even lay down. Tonight I will begin my search to find a sports med doc as you recommended. If I have to pay out of pocket for an MRI I guess I will. This is crazy that the docs simply refuse to give me an MRI.

[@user-lm6fl2wq8g]

Hello, i have a question. If i go in for an MRI lambar spine without contrast.. will the show inmages of my brian or scan my brain or take any picture of my brain, or have anything to do with my brain? Or since its for lambar spine, will they only focuse on that and other parts of my body? I have high anxiety cause i dont want my brain involved.. thanks so much. I hope to hear back from you soon?

[@ghulamyazdani2448]

sir i have high loewer back pain cant seat more then 15 minutes and also have neck pain, cant rotate neck properly sir please any suggest to me my age is 22 years

[@apexmovebetter]

I would try lower back extensions in standing. Check Out my video on red flags to make sure you don’t need to see a doctor

[@gracerukuiloter2997]

Hi Ghulam. I have exactly the same problem. How did you sort out the issue? I will really appreciate, bro.

[@jaswantjaswant1431]

Hiii

[@josesifuentes2592]

I don’t know why doctors or pt get paid to beat around the bush.. basically this guy is saying they will rather give you physical therapy and then determine / maybe incline that plausibly you might need an mri.. the fact that he is taking the time to make a video instead of working should be alarming on its own.

[@apexmovebetter]

Interesting.

[@Rgsetters]

Jose. MRIs are used to identify surgical or injection targets for lower back pain. Spinal surgery is very invasive and risky and is often unsuccessful. Most people I see don't want invasive treatment options for something that mostly will settle with conservative measures like physiotherapy. MRI is a waste of patients time, clinicians time and resources if it won't change treatment. People often want an MRI as reassurance. But often it doesn't reassure people as nearly every MRI will have some sort of finding. Most of these are incidental and aren't causing any issue. Unfortunately patients with back pain don't often have the knowledge to know what's incidental and what's relevant to their pain and the findings that will inevitably be on the scan can cause more anxiety around back pain. Also we see people who have unnecessary MRIs are more likely to have unnecessary surgery. People who have unnecessary MRIs spend more time off work. They waste tax payer money in publicly funded health systems and drive up insurance premiums in privately funded health systems. No healthcare professional would deny an MRI to those that truly need them, that's not why they got into healthcare. Unfortunately healthcare professionals spend a lot of time talking to people like you, who think you know when an MRI is best and are quite rude and abrasive and it just makes an unpleasant experience for everyone. Take care.

[@ANGELSURS]

@@Rgsetters not true

[@Rgsetters]

@@ANGELSURS which part

[@kitten1122]

lmao this guy really said WE have to take care of the cancer we're not even allowed to know if we have 😂 newsflash doc, that's YOUR JOB

[@johnhein2539]

TLDW?

[@apexmovebetter]

Maybe

[@MRMq123]

Smj ni aiii

[@apexmovebetter]

Nir sure what that means

[@Zaidzookhan]

Cause u dont know English :)

[@roadwarrior8560]

too much waffling. get to the point....

[@apexmovebetter]

Wow. Harsh.

[@jeffghant4760]

If you injure your back, you're f*cked for life.

[@apexmovebetter]

Not always but you should seek professional help

[@jeffghant4760]

@@apexmovebetter I'm actually paraphrasing what my gym teacher told me in highschool. I've strained my back 2x since and I'm only 32. It may have something to do with my driving posture since I drive for a living. I don't know.

[@apexmovebetter]

@@jeffghant4760 it can be affected by driving posture and range of motion loss.

[@RashadSims-bh3zz]

Can u get an x ray as well?

[@apexmovebetter]

Generally a xray is not recommended for first 6 weeks.

[@RashadSims-bh3zz]

@@apexmovebetter thank u