May 11th, 2012

Health N' Sports: MRI Study For Injuries

Staff Report

Health N' Sports: MRI Study For Injuries
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Louisville Orthopaedic shares insight on the scan 

As a part of the Louisville Orthopaedic Clinic, the Sports Rehab Team physical therapists are knowledgeable and trained in the latest advancements and techniques available in sports rehabilitation. 


On a weekly basis, the Health N’ Sports Update will give information on prevention, recovery, and include special offers, as well as general health tips that would be beneficial to all. If there is a specific topic you’d like to know or hear more about, email future suggestions to


For most cases of general acute low back pain (LBP), an MRI is not necessary for diagnosing or planning your medical treatment. An MRI (Magnetic Resonance Imaging) is considered to be the single best imaging study of the spine to help plan surgical treatment for low back pain (LBP), such as decompression or spinal fusion. These scans are very sensitive to revealing information about the health of the discs including a lumbar disc herniation that pinches the nerve roots and causes back pain and/or leg pain, often referred to as sciatica.

MRIs are also a useful tool for detecting disc degeneration, tumors, spinal stenosis, and spondylolisthesis. (note, spinal disc abnormalities may be described as herniated disc, pinched nerve, bulging disc, protruding disc, slipped disc, or prolapsed disc). 

X-rays are routinely performed in the doctor’s office, but while an X-ray is an excellent study used to look at the bones of the back, it does not look at the nerves or the discs. X-rays or CT scans (more detailed x-rays) may be used when there is concern of a fracture such as following trauma.

Since MRIs are useful for detecting nerve impingement, they are often ordered if the patient has pain, numbness, tingling, or weakness into the leg or arm which are indicators on exam of possible nerve irritation.

However, diagnostic imaging is not necessary to guide routine decision making about how to best treat low back pain. The American College of Physicians (ACP) guidelines issued in 2011 that MRI for an acute episode of LBP should only be used if a serious underlying condition is suspected or if symptoms of numbness and/or weakness in leg are progressing (severe progressive neurological deficits).

If you have LBP and/or leg pain and are wondering if you should get an MRI scan, the following indicators have been developed by ACP to explain when a scan is useful:

  • After 4 to 6 weeks of leg pain if the pain is severe enough to warrant surgery
  • After 3 to 6 months of low back pain, if the pain is severe enough to warrant surgery
  • If the back pain is accompanied by constitutional symptoms (such as loss of appetite, weight loss, fever, chills, shakes, or severe pain when at rest) that may indicate that the pain is due to a tumor or an infection
  • For patients who may have lumbar spinal stenosis and are considering an epidural injection to alleviate painful symptoms
  • For patients who have not done well after having back surgery, specifically if their pain symptoms do not get better after 4 to 6 weeks

It is estimated that 30% of MRIs show evidence of disc injury even when the patient has no symptoms, and in people over aged 60, 90% of MRIs will reveal bulging disks at some time. Furthermore, wear and tear with aging causes normal disc degeneration and arthritis in the joints. However, not everyone with these conditions will develop painful symptoms.

Important to understand the causes of back pain are complex, and often it is difficult to get an accurate diagnosis as to the cause or source of one particular patient’s pain. In the case you do seek medical advice for your LBP, do not hesitate to ask why a particular imaging study is performed and how results of the tests may affect or determine your course of your medical care.

Key points:

MRI can provide diagnostic assistance but should be interpreted and correlated with other symptoms (such as the duration, location, and severity of pain), and any neurological deficits on their physical examination including decreased strength, sensation).In most cases it is not necessary for an MRI to be performed before starting physical therapy treatment, and earlier initiation of physical therapy can potentially speed up your healing and return to full activity. A PT can perform a thorough physical examination to determine the best course of management for your low back pain and whether you require imaging (X-ray, MRI, CT scans, etc) to rule out a serious problem.

Louisville Orthopaedic Clinic offers open-MRI on-site, as well as spine specialists.

Louisville Orthopaedic Clinic

Main Office: 502-897-1794

Physical Therapy: 502-897-1790


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