I speak frequently about the continued overutilization of diagnostic imaging in the management of musculoskeletal disorders. As humans we are use to looking at wrinkles on the outside. Some of us may choose to inject the wrinkes with a poison to paralyze the surrounding musculature in order to “flatten” them. However, most agree that in and off themselves these wrinkles on the outside are pain free and a normal part of this wonderful journey we call life. As humans we are not nearly as comfortable peering inside the body and seeing wrinkles on the inside. This is not at all surprising as MRIs are a very recent invention (like while I was in high school and I am not that old). The vast majority of us have never even peered inside of our body except occasionally within our mouth and perhaps our nose (PS this trimmer has a light). Those of us without visual deficits are used to seeing our reflection in a mirror and are not startled into making poor choices. However, we need to look no further than wild animals (see here) who react strongly in various ways when confronted with this foreign image of self which is often scary.
At Manipalooza this past weekend in Denver I was surrounded by passionate PTs who are making a difference. However, I continue to hear far too many stories about patients who are increasingly younger with musculoskeletal pain being “scared” into a surgery by showing a foreign image (i.e. an MRI of their body) and told that bad things will happen if they don’t act quickly with a surgical intervention. It is not surprising that patients are scared sick. Hopefully the recent image shown above in this short article from the New England Journal of Medicine will have an impact. The article described a 29-year-old woman with new-onset right leg pain and paresthesia. There were no bowel or bladder symptoms. Magnetic resonance imaging (MRI) of the lumbar spine revealed a lumbar disk herniation resulting in substantial spinal stenosis and nerve-root compression. She elected conservative treatment with physical therapy and an epidural injection of glucocorticoids. A second MRI at 5 months showed resolution of the herniation. Please share this example liberally, make posters on your wall, and send it to family members. Images are more powerful than words. All surgery is not bad, however it should be a rare event when it comes to low back pain.