MRIs: The Ninja Guide

In This Guide

The Way of MRI

An MRI is often the first step into the hamster wheel of ineffective treatments and pain.

Things You Should Know

Knowledge is power, especially when it comes to making important decisions about your health.

When MRIs are Useful

An MRI can be very useful to rule out red flags and serious conditions such as fractures or cancer.

Why MRIs are Overused

MRIs are too often ordered for reasons which have nothing to do with a legitimate medical use.

The Way of Ninja Physio

Get real care, long-term results, and avoid the never-ending hamster wheel of pain.

Getting Peace of Mind

Getting an MRI is often about peace of mind. We hope this article helps you put your worries to rest.

MRIs: Gateway into the system

In my physio practice, I constantly see people sent to get MRIs that they don’t really need, wasting time and hundreds (or thousands) of dollars. The MRIs don’t really provide more info than I can get myself through physical tests, and they ultimately don’t change the treatment options available to the client anyway.

In many cases, what the MRI does do is convince people that there’s something wrong and then funnel them into the system, with its hamster wheel of appointments, delays, drugs, and procedures, which too often maintain the pain instead of eliminating it.

MRIs have their use, but in this guide you’ll learn why MRIs are often unnecessary, potentially counter-productive, and what you can do if you want to conquer pain instead of manage pain the rest of your life.

The Way of MRI

The hamster wheel of pain typically goes something like this:

  1. You have pain
  2. You see a doctor
  3. The doctor orders an MRI
  4. The MRI comes back with abnormal findings
  5. Concerned, you get the suggested treatment (most likely steroid shots, at first)
  6. It works temporarily, and you get sent to physical therapy
  7. Physical therapy doesn’t work so you’re offered increasingly invasive treatments (RFA, neurostimulator, surgery)
  8. Months or years later, you’re still in pain, but you keep doing these things because some pain relief is better than being in pain all the time. You’re now officially in the hamster wheel of pain
Hamster wheel on shelf
Would you like to be in one?

It looks something like this:

The hamster wheel of pain, often lasting years, decades, or a lifetime.

And here’s what one of our clients went through before finally finding us:

Roger: MRIs, injections, and decades of pain

In his early 20’s, Roger suffered a back injury after falling off a tank in the Army. He was in severe pain for several days, and could hardly bend over or stand up. The doctor ordered an MRI, told him that he had arthritis and a herniated disc, and gave him some pain meds and muscle relaxers to deal with it.

He managed his pain this way for several years, but then injured his back again while deadlifting. He got another MRI, which again came out positive for a herniated disc. The doctor offered him a steroid injection to reduce the pain, and also told him that he’d eventually need surgery. Roger didn’t want surgery, so he went with the injection, which eased the pain for a few months. For the next 20 years, he got injections every 3-6 months.

Since the pain would come back before he was allowed to get the next injection (due to their side effects), he also tried military physical therapy, acupuncture, chiropractic care, and massages. Some of those things helped for a bit, but he never found something that would eliminate the pain long term.

He finally surrendered to the idea of having back pain the rest of his life and its limitations. Over time he stopped lifting heavy weights, stopped playing basketball, and started gaining weight. He couldn’t be active himself, but he enjoyed coaching youth sports. As the pain got worse, he stopped doing that as well. He took a job as a school bus driver to keep giving back to his community, but as it became increasingly painful to get on and off the bus, he was thinking he’d have to stop doing that, too.

Luckily, he found us in time to stop and reverse that trend.

Pain is one of those things that will slowly (and sometimes quickly) take over your life. Many people have a similar history, and it all often begins with the “all-seeing” MRI.

1. Pain and MRI abnormalities are not necessarily correlated

MRI found abnormalities... but I don't have pain.
MRI didn't find abnormalities... but I still have pain.

Many people are told by their doctors that their pain is due to damage to their tissues, joints, muscles, etc, and that they need to get an MRI to find out exactly where this damage is.

This can be misleading because there is no correlation between abnormal results on an MRI and pain levels. In fact, the majority of people with no pain will have abnormal MRI results, including arthritis, degenerative disc disease, meniscus tears, or cartilage damage!

Check out this video where doctors from the Dartmouth-Hitchcock Spine Center explain these issues regarding MRI results:

Play Video

No correlation between MRI findings and low back pain in over 3,000 people

In this study, they took MRIs of over 3,000 people, and their MRI results had little to no correlation to their level of low back pain over a six year follow up. Their conclusion:

Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with low back pain, with almost all effects less than one unit on a 0 to 10 pain scale.

223 out of 230 people with no knee pain had abnormalities in their MRI

Here they took MRIs of 230 knees that had no pain, and 97% of them had abnormal findings on their MRI such as meniscus tears, cartilage lesions, bone marrow edema, tendon lesions, and ligament ruptures.

Nearly all knees of asymptomatic adults showed abnormalities in at least one knee structure on MRI. Meniscal tears, cartilage and bone marrow lesions of the patellofemoral joint were the most common pathological findings.

If 97% of them had abnormalities like tears, lesions, and ruptures, why didn’t they have pain?

Over 50% of people age 30+ with no pain show disc degeneration in their MRI

This study shows the prevalence of several different abnormalities in different age groups who have no low back pain. If you’re over the age of 20, there’s a 37% chance your MRI will show you have disk degeneration even if you don’t have back pain. That number jumps to 52% if you’re 30!

Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.

Image FindingAge
20 years30 years40 years50 years60 years70 years
Disc degeneration37%52%68%80%88%93%
Disc height loss24%34%45%56%67%76%
Disc bulge30%40%50%60%69%77%

The chance that someone will have an abnormal finding on their MRI, by age, even if they don’t have pain.

2. MRI results can vary greatly depending on the doctor looking at them

In this study, a 63 year-old woman with a history of low back pain got 10 different MRIs at 10 different testing locations over a three-week period. The results:

  • 49 different findings
  • Only one finding was consistent in 9/10 MRI reports
  • Some reports showed disc herniation in 5 lumbar segments, one MRI showed no disc herniation
  • Central canal stenosis was present in two reports, but not present in two other reports
  • Four reports showed nerve root involvement and four reports didn’t show any nerve root involvement

Where a patient obtains his or her MRI examination and which radiologist interprets the examination may have a direct impact on radiological diagnosis, subsequent choice of treatment, and clinical outcome.

So what was really going on with her? What was the cause of her back pain? Your guess might be as good as some of the doctors’.

3. Early use of an MRI is associated with increased medical costs and unneeded procedures

This study of over 400,000 participants found that getting an MRI early was linked to a 12X increased likelihood of lumbar surgery, 20% increase in use of opioid prescriptions, and $2,500 increase in total healthcare costs.

The association between early imaging and increased utilization was apparent even in a setting largely unaffected by incentives of fee-for-service care. Early scans are associated with excess surgery, higher costs for other care, and worse outcomes, including potential harms from prescription opioids.

Here’s another systematic review that shows that getting an MRI early in the process is associated with increased medical costs and increased length of disability.

patients with acute low back pain without red flags who received eMRI had increased length of disability compared to those who did not receive eMRI.

“It is very rare for an M.R.I. to come back with the words ‘normal study’“

In this New York Times article, Dr. Andrews states, “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.” Since the MRI is very likely to come back with abnormal findings, including damage to tendons or cartilage, a surgeon can use it to justify a procedure that may really be unneeded.

The article talks about baseball pitchers, but the same applies to anyone who is physically active; their MRI will show normal wear and tear that is of no consequence.

The article goes on to explain how there is a lot of overuse of MRIs in the medical system.

Of course, surgery is necessary sometimes. Do you have a broken bone? Did your knee tear severely in 4.5 different places? Do you have cancer? Then you’ll probably need surgery. But for many other less severe things, there’s a very good chance that you can live pain free without surgery (more on that later).

4. You’ll most likely be worried regardless of the results

At the end of the day, the MRI result will come back as normal or abnormal. Either case may give you something to worry about.

In the case of normal findings, you’ll likely be worried because the doctor can’t find why you’re experiencing pain. Maybe that means it’s something really bad? In the case of abnormal findings, you’ll worry because the MRI confirmed that there is indeed something “wrong.” But as mentioned before, the MRI would probably find something “abnormal” even if you didn’t have pain.

5. The MRI doesn't change the usual options

At the end of the day, the MRI won’t change the treatments options presented to you. You’ll likely be lead into the hamster wheel of endless appointments, drugs, steroid injections, nerve ablations, neurostimulators, physical therapy, and/or surgery.

An MRI won't change the typical options of drugs, shots, ablations, and surgery.

When an MRI is Useful

Of course, MRIs do have their legitimate uses. As a physio, I look for red flags that may indicate a more serious condition than a simple musculoskeletal issue by asking a series of questions, such as:

  • Do you have any unexplained weight loss?

  • Do you have a fever of >102 degrees?

  • Do you have any bowel or bladder problems?

  • Do you have any unexplained weakness in your legs?

If someone is exhibiting these symptoms, then an MRI may be a good idea to find or rule out serious conditions, such as:

  • fracture (<7.2%)

  • cancer (<2%)

  • infection (<2%)

  • aneurysm (<1%)

  • cauda equina syndrome (<2%)

That said, these conditions account for <5-7% of cases. If someone isn’t exhibiting the above symptoms, and most people aren’t, then an MRI isn’t really called for.

Outdated Training, Bean Counters, and Lawsuits: Why MRIs are Overused

If MRIs aren’t necessary in so many cases and they can lead to worse outcomes and more expensive procedures, why are they used so much?

This news article goes into more detail, but here’s quick list of the main reasons why a doctor may order an MRI that’s not really necessary:

  • Outdated training: It’s how they were trained in school a while back and they haven’t stayed up to date with the latest knowledge.

  • Patient satisfaction: A patient requests an MRI, and the doctor orders it just to satisfy them.

  • Insurance: Some insurance companies require an MRI in order to approve certain procedures.

  • CYA: Extensive testing can help create a stronger defense in case a patient sues.

  • Revenue: Some doctors own their own machines or are pressured by hospital systems to order MRIs to increase revenue.


The Way of Ninja Physio

This is what the path looks like at Ninja Physio:

And here’s what it’s like in real life:

Patrick: Emergency room to salsa dancing in six weeks

Patrick injured his lower back deadlifting at the gym. He first went to urgent care, waited for five hours to get an X-ray and an injection in his hip, then went to a low-cost chiropractor which only made it worse. His pain was so bad he could barely walk, couldn’t sleep, and couldn’t work.

After a few days in excruciating pain, he did a local search and found us. We were able to get him in the next day. He signed up for the program, and after six weeks he was back to scuba diving, horseback riding, and deadlifting correctly and confidently.

While he was going through his Ninja program, he was also waiting to be seen by the VA. Several weeks into his program, his MRI came back positive for a disc herniation, but it didn’t bother him because I had already diagnosed it and he was largely pain free. 

After he had completed his program with us, the VA was referring him to neurology for a surgery consultation, but he decided not to go because he was already pain free and back to living.

That’s it?

Did you notice how simple and non-contrived that was? That’s what happens when you take insurance out of the equation, actually put people first, and combine that with a skilled team that cares. There’s no months of waiting, no approvals needed, no invasive procedures, no drawn-out treatment plans, and no hamster wheels.

Getting Peace of Mind

For many, MRIs are really about peace of mind. There’s something about having a high-tech machine look inside to detect what a human seemingly can’t. It takes a complex machine to decipher a “complex” problem, right?

Ruling out red flags

But as we’ve seen, most red flags (cancer, fracture, aneurysm, etc) can be ruled out by asking simple questions or performing simple tests. As far as musculoskeletal pain goes, if you’re not in excruciating pain (can’t walk), you most likely do not need to get an MRI and do not need surgery. Many findings on MRI results (meniscus tears, disc herniation) can also be diagnosed by a physio just by performing physical tests.

If doctors haven’t found what’s wrong

If doctors haven’t been able to get rid of the pain, odds are it’s not because of insufficient MRIs. Something to keep in mind is that the system has more to gain by maintaining and managing pain than than by eliminating it for good. It’s sad, and it shouldn’t be this way, but that’s what it has become. If you want real solutions that aren’t wasting your time, money, health, and life, you’ll need to think outside the system. Direct pay doctors work directly for you, not for the system, and therefore can provide you with a higher level of care and outcomes.

We’ve helped many who have “tried everything”

It might also help to know that we have a 97% success rate at significantly reducing or eliminating pain long term. This includes clients that had “tried everything,” that were told by doctors that they need surgery, and even that they’d have to live with pain the rest of their lives. Herniated discs, meniscus tears, rotator cuff tears, arthritis, to name a few… we’ve seen them all and eliminated the pain without drugs, injections, ablations, and surgery.

Once again, it’s what happens when you actually put people first and combine that with a skilled team that cares.

If you’re getting an MRI

If you’ll be getting an MRI, you should now be armed with knowledge to help you take control of your health. Remember this as you’re nudged into the hamster wheel of pain:

  1. MRIs are great at finding red flags, but not so great at finding the true source of musculoskeletal pain.
  2. Due to normal wear and tear, your MRI is very likely to find “abnormalities,” whether you have pain or not.
  3. The MRI findings can vary greatly depending on the doctor interpreting them.
  4. Regardless of the results, the options presented to you will still be drugs, injections, ablations, surgery, and physical therapy.
  5. The system is optimized for profit, not for health outcomes, and has a lot to gain by maintaining and managing pain instead of healing and eliminating it long term.
  6. If you want real, long-term outcomes, you’ll very likely need to think outside the system.

Now, more than ever, you must take your health into your own hands and ask a lot of questions. Challenge your doctor (nicely). See different doctors and get different viewpoints on your symptoms, results, and treatment plan.

Ready When You Are

We realize that there’s a lot of conflicting information and that navigating the pain landscape can be very confusing. I hope this guide has helped, but if you or someone you know is thinking about getting an MRI, or if you’ve gotten your MRI results and not sure what the best next step is, we are happy to go over your situation and options with you. Just reach out!

And if you’d like to avoid the hamster wheel of pain altogether, come see Ninja Physio first! It’s the shortest, most straightforward way to achieve life-long results and come back better than ever.

The Ninja Physio team