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MRI. When Should You Have One?

Should I Have an MRI?

“Should I have an MRI?” is a frequent question asked by our patients. Interestingly we have rules regarding when one should be ordered. Generally, if a patient is experiencing radiating pain into a limb, has numbness and tingling and associated weakness in their limb which is progressively worsening we will consider ordering an MRI. Of course, other factors to take into consideration include non-response to treatment and the duration of symptoms.

If a patient presents with sciatica and has weakness in their foot they will be monitored to see if they improve with treatment. If their weakness and pain dissipate over the next few weeks we will not order an MRI. Alternatively, if their pain continues and the weakness does not subside after a few weeks we will suggest an MRI.

In the above example, we will usually be looking for a disc protrusion. Keep in mind, not all disc protrusions are the same. Just because one is identified, the nerves may not be compressed. However, if they are, we may refer the patient to their GP for specialist referral.

In other cases, a patient may have sciatic pain without weakness, numbness or tingling. Generally, we will be looking for a fissure in the wall of the disc. Fortunately, in most cases, these usually recover well.

If a young athlete presents with sudden lower back pain which is worse on bending backwards, it may be critical to order an MRI. In this case, to look for an impending defect in the bone. We will be looking for inflammation or oedema in part of the vertebra called the pars. It is important to limit the young athlete’s activity for several months. This helps reduce the chance of a stress fracture in the bone called spondylolysis. Once this happens it can’t be reversed.

Other reasons for referral may include, sudden weight loss, unexplained swollen lymph nodes, fever associated with back pain or bladder or bowel weakness. Headaches can be another reason for referral however this should only be performed when other clinical signs and symptoms are present such as worsening headaches, seizures, personality changes, unexplained vomiting, weakness on one side of the body and difficulty walking.

It is not possible to discuss all reasons for acquiring an MRI in this blog article. However, we will not refer you for an MRI unless we believe there is a valid reason for doing so.

A neuromusculoskeletal medicine specialist focuses on the evaluation and management of patients suffering from biomechanical spinal, and extremity joint dysfunction, pain syndromes, and neuromusculoskeletal conditions.

The board-certified chiropractic neuromusculoskeletal medicine chiropractor may utilize patient-centered, evidence-based, and outcome-driven treatment strategies which could include but may not be limited to: spinal and extremity manipulative therapy, and a wide array of physical medicine and non-surgical procedures to achieve optimal outcomes.