Should I ask for an x-ray or MRI?

Long story short - likely not. If the physician didn’t suggest it, it’s probably because it’s not necessary, or going to change course of treatment.

There are actually particular indications for when we recommend an x-ray. If the pain-inducing event wasn’t traumatic, we’d look for things like ongoing numbness in the extremities, isolated point tenderness on a bone, inability to weight-bear, significant range of motion restriction, no immediate pain after an injury, and other factors. Obviously there are always exceptions based on clinical judgment, but that’s why we refer to physicians if there’s any doubt :)

For chronic pain, such as in the neck, low back, hips or knees, we often don’t need any imaging to create a treatment plan. That’s because our hands-on tests are actually shown to be more valid and reliable than results of imaging studies. We can still specify muscle and ligament injury grades, check sensation and strength relating to particular nerves, isolate muscle strains, and recognize disc versus mechanical back and neck pain.

An MRI is great for showing us particular things that may be more ominous, or to assess for what a doctor calls a “red flag”. These flags are things such as unexplained weightloss, fever, night sweats, incontinence, severe localized pain at rest, joint instability where surgery may be warranted, etc.

The other thing an MRI shows us, is things that may not be relevant. It’s absolutely normal for a scan to show some joint changes as we age, and it’s often nothing to be alarmed about. These “false positives” relate to hips and knees, rotator cuff tears, disc herniations, and meniscus injury. They often don’t correlate to pain; we see patients all the time with pain and no findings on scans, and the opposite where people with absolutely no symptoms or history do show these positive findings.

What that information tells us, is that a finding on a scan might not tell us anything about what’s leading to the symptoms being felt. That MRI picture will show us a picture of what body tissue looks like at a particular point in time.

Goals of rehab are always the same, regardless of injury- assist in healing and symptom management, facilitate range of motion and strength gains, and increase endurance and confidence.

As a patient, you’re much better off seeing a good athletic therapist, physiotherapist, or sport medicine physician, to lay out a plan of action. If you have a good team, these clinicians will refer to each other when necessary.

Megan Pomarensky