, Gloucester, MA

March 1, 2013

Useful as diagnostic, MRI has limitations

On the Mend
Joe DiVincenzo

---- — Here in America, we like to know things with as high a degree of certainty as possible. From the weather to the federal interest rates, it’s safe to say that we value accuracy. And arguably above all else, we expect answers to our medical problems.

After all, is there anything more important than your health?

The art of diagnosing medical problems is an ever-evolving process, and fortunately, the clinicians of today are only a few button-pushes away from the most powerful diagnostic tools of all time.

In the treatment of spine pain, magnetic resonance imaging (MRI) has become one of the most widely employed testing measures, readily available to diagnosing practitioners in nearly all areas of the country, both urban and rural.

But are we putting too much stock in an MRI? Any practitioner will tell you that although it can be extremely useful, there are definitive limitations on the clinical utility of MR images.

So if your back or neck has been hurting and you’re thinking of asking your doctor for an MRI, here are some things you should know first.

Your doctor may want you to try therapy first. An MRI costs insurance companies more than a $1,000 – not to mention any out-of-pocket expenses you may incur. In some instances, a round of therapy is considerably less expensive — and it treats the problem.

MRIs are sensitive but not specific. It’s helpful for “ruling out” but not necessarily ‘ruling in’ a condition. Although MRI offers a detailed anatomical picture of your spine, it won’t necessarily indicate which structure is the one generating pain.

Some physicians will order an MRI only if you’re planning on having surgery or some form of injection therapy. Obtaining a detailed picture of your anatomy is helpful during the surgical or injection planning process, but it won’t necessarily guide conservative management strategies. Doctors know this and often are reluctant to order an expensive test they know will have little contribution to your healing.

When it comes to the spine, an MRI cannot always decipher between new and old injuries. There are certain markers that show up routinely which help indicate whether a pathology is acute or chronic — but in the spine these markers are not always present or accurate, making the clinical history of the disorder the most important feature of the diagnostic process.

An MRI is just a snapshot in time. Remember that it’s a picture of your spine taken while you’re lying flat on your back — not the best representation of how we as humans live our day-to-day lives. Spinal conditions can vary greatly with changes in weight bearing. It’s a good tip to keep in mind.

An MRI is likely not a necessary step to solving a case of back or neck pain. Clinicians use a variety of front-line tests capable of detecting anatomical deficit in the spine which help with the formulation of a treatment program. Generally speaking, a clinician skilled with his hands is often as effective as an MRI.

Gloucester resident Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He writes “On the Mend” weekly. Questions may be submitted by email to