MRIS LEAD TO MISDIAGNOSIS AND OVER TREATMENT
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MRIS LEAD TO 
MISDIAGNOSIS 
AND OVER 
TREATMENT
http://www.virtualphysicaltherapists.com/
Magnetic resonance imaging (MRI) allows us to see a clear image of soft tissues and deep structures 
inside our bodies. They can create high-resolution images of the entire musculoskeletal structures, 
including bones, tendons, muscles, ligaments, and nerves. MRIs are valuable as they show details when 
there are red flags. 
But MRIs also show natural changes due to aging, and they cannot decipher painful from non-painful 
structures. Too often, misdiagnoses are made based on such findings, and the actual cause of pain is 
overlooked. MRIs lead to misdiagnosis and over treatment.
When used correctly, MRIs are an important tool, but they are overused and have lead to over-
medicalization. 
If you take a picture of the inner mechanics of your cell phone it may show water damage, etc., but only 
by using your phone can you tell if it actually works. An MRI takes a great picture, but only by moving and 
using your muscles and joints can you tell if they are painful and function correctly.
The use of MRIs in the US continues to grow at an alarming rate despite evidence that improved patient 
outcomes do not accompany it. Overutilization of imaging in individuals with low back pain has been 
correlated with a 2- to 3-fold increase in surgical rates over the last ten years and probably the same 
with other joints not yet studied. MRIs act like a sales funnel. Being told that something is wrong causes 
anxiety and fear. You then seek treatment as you search for a “fix”.
MRIs are harming many by causing fear and often a misdiagnosis, both leading to unnecessary 
treatments and a higher rate of chronicity.
If MRIs Show a Clear Picture of Underlying Structures – How can They Lead to Misdiagnosis and 
OverTreatment?
Research has shown that 43% of isolated extremity symptoms originate in the spine. If you have pain in 
your shoulder, elbow, wrist, hip, knee, ankle, etc., there is a high likelihood that your symptoms actually 
come from a problem in your spine. Getting an MRI of your painful joint will likely uncover natural age-
related changes and, 43% of the time, not the actual cause of pain. Instead, a problem where the pain is 
located will be unearthed and falsely confirmed as your diagnosis.
Age-related changes are part of the natural process, like wrinkles on your face and gray hair, and do not 
cause pain. Signs of degeneration are present in very high percentages of healthy people with no 
problem. Asymptomatic 20-year-olds have a 37% chance of degenerative disc disease and a 30% chance 
of disc bulge. Many imaging-based degenerative features are likely part of normal aging and are not a 
cause of pain.
Disc degeneration, bulging, and even herniations are often found in those with no back pain. 
Cancer, infection, and problems within your internal organs often refer pain to the spine. An MRI is 
performed where the symptoms are located will more than likely show changes, and the true cause of 
the problem will be overlooked.  
Mechanical Assessment Instead of an MRI for Precise Diagnosis 
Rather than a costly MRI, a simple Mechanical Assessment should be performed to uncover the 
underlying cause of pain.
 
 
A mechanical assessment identifies problems within your musculoskeletal system by the affect of 
movement on your muscles and joints and if there is a change in your symptoms. This starts by first ruling 
out your spine, no matter where your symptoms are located – even for pain in your toes. You simply 
move the spine to see if it affects your symptoms. After the spine is ruled out, the clinician will assess the 
muscle and joints around where your pain is located. Musculoskeletal problems are mechanical in nature 
and must be aggravated or relieved with movement.If positions or movements do not affect the 
symptoms, then testing for non-mechanical such referred symptoms from internal organs or cancer must 
be investigated.
Medical guidelines “strongly” discourage using MRI and X-rays in diagnosing low back pain because 
they produce many false alarms.
Over fifteen years ago, the American College of Physicians and the American Pain Society strongly 
recommended against imaging for managing low back pain without suspicion of underlying serious 
pathology (e.g., cancer, infection, or fracture). Their 2007 
guidelines for the management of low back pain. recommendations:
Instead…Get up and MOVE! Walking and moving are the best thing you can do for posterior herniations 
as walking places a slight anterior force on the herniation pushing it back in the center direction. It is 
essential to minimize your sitting and maintain activity within your threshold. Research has shown that 
those that continue to work within their tolerance have faster recovery than those that stay home from 
work.
They take on a passive patient role.
Research has shown that the more involved you are with your care, the better the outcome. Healing is 
an active, not a passive process. Most current protocols for treating back pain and herniations are 
passive, including medication, massage, injections, TENS, surgery…all of these have not shown any 
benefit. Instead, they create a patient role. 
The more passive care you receive, the longer you suffer and the higher rate of chronicity and disability. 
Instead, become empowered. Learn what position/activities caused your herniation and what you can 
do to avoid them as well as heal.
Remember to Mistakes to AVOID with a Herniated Disc:
Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low 
back pain 
Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or 
progressive neurologic deficits are present or when serious underlying conditions are suspected based 
on history and physical examination 
 
 
MRIs are a gateway to Surgery and Increase Healthcare Spend!
When you are in pain, you want to know what is wrong, and every patient wants an MRI because they 
believe it will clearly show the underlying problem.Almost 25% of those with low back pain will still 
receive imaging, even though it is not following current guidelines. 
Imaging improves patient satisfaction, but numerous studies have shown that improper use of MRIs is 
also associated with misdiagnosis, poorer patient outcomes (persistent pain and chronicity), increased 
downstream healthcare utilization (increased back surgeries, opioids, injections, treatments), and 
increased healthcare costs (1, 2,3,4,5,6,7) 
 
 
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MRIs often Cause Fear and Lead to Chronic Pain.
The knowledge that an abnormality is found would cause anyone to feel that something is wrong, and 
they will do whatever is needed to fix it. Hence the increase in treatments, injections, and surgery linked 
to those that have received MRIs. Not only do MRIs increased healthcare utilization, but they also install 
fear. Fear leads to avoidance behavior and is the oxygen to chronic pain. When you are scared of causing 
more pain, you stop moving and lack of movement leads to unhealthy stagnation and initiates the 
chronic pain cycle. An MRI must be used wisely, and the patient is educated on the findings and rates of 
natural aging to decrease their fear. 
MRIs have a vital role, but they must only be used with wisdom – after a thorough mechanical 
assessment and red flags are found.
Are MRIs Reliable?
We naturally assume that MRI is a reliable technology, but they are just a picture that can have a 
shadow and require education and experience to interpret correctly. Researchers had a 63 yo
 volunteered go to 10 different MRI centers in a short period to compare the interpretations from 
different MRIs and radiologists. The researchers determined that each radiologist made numerous 
errors. 49 distinct findings were gathered, and not one was found in all reports -adding a question to the 
reliability of the testing we hold as a gold standard.
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The most common reason to obtain an MRI is for low back pain, and a common abnormality found is 
spinal stenosis. Researchers sought to find if radiographic findings would match clinical findings for 
stenosis. Radiologic and clinical impressions did not correlate. The MRI could not determine if spinal 
stenosis is a cause of pain. MRIs are a powerful tool and can clearly show spinal canal narrowing, the 
basis of diagnosing spinal stenosis with MRI. It questions then the assumption a narrowed spinal canal 
alone can cause back pain.
Another researcher performed MRIs on those with no low back pain and then a repeat MRI if a patient 
did develop an episode. 84% of those that developed pain had unchanged or actual improved imaging 
after their pain developed.
90% of the initial MRIs showed significant negative findings, even though they had no low back pain and 
included:
50% had either disc protrusion or extrusion, nearly
30% had annular fissures
2% potential root irritation.
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Many have positive MRI findings even though they have no pain, so instead of being a positive finding 
they should be notes as natural changes.
MRIs Must Come with Education
Our bodies have an amazing way of healing. For instance, 67% of disc herniations
 spontaneously reabsorb, and the larger they are, the more likely they are to be reabsorbed.
Patients are not provided education or explained that some MRI findings are part of natural aging or 
that degenerative changes found might be meaningless. Our bloodwork comes with ranges. MRIs should 
also come with notes about the percent of natural degenerative changes seen in asymptomatic 
individuals as we age. Instead, MRIs often lead to additional tests, follow-ups, and referrals and are a 
gateway to invasive procedures of questionable benefit.
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VPT’s clinicians know that it is challenging to counteract negative consequences following an imaging 
finding of degenerative disc disease, herniated disc, rotator cuff tear, or arthritis, to name a few. A 
patient will typically focus on this adverse finding as to the source of the problem and feel that they are 
broken until surgery can fix it.
In reality, these findings often have nothing to do with the pain they are experiencing, and instead, 
these changes were there long before the symptoms appeared. It takes a long time after the patient is 
symptom-free to convince them they are ok despite their MRI. 
Degenerative changes are often a natural part of aging, like wrinkles and gray hair, and do not cause 
pain.
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VIRTUAL 
PHYSICAL 
THERAPISTS
[email protected]
HTTP://WWW.VIRTUALPHYSICALTHERAPISTS.COM/
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