Dr. Dallin Page, DPT
“Should I Get An X-Ray or MRI Before Seeing My Physical Therapist?” The Answer Might Surprise You…
Updated: Jul 22, 2022
As a Physical Therapist, this is a question that I get asked quite a bit. Many people believe that they cannot or should not come into the office to see me without first going to get diagnostic imaging done.
This is due to a belief that 1) it would not be safe to see a PT before getting imaging because the therapist may miss something and, in turn, inadvertently hurt the patient or 2) the PT would not even know how to treat the pain anyways if they did not have a specific anatomical diagnosis for the cause of the pain.
The truth is that as a healthcare system in general we place a TON of emphasis on diagnostic tests. Every patient wants a clear, simple diagnosis for their pain.
In other words, they want their medical provider to say:
“By looking at this specific test (ie. X-ray, MRI, etc.), we can clearly see that this specific structure (ie. ligament, muscle tendon, cartilage, bony structure, etc.) is ‘damaged’ and is the source of your pain.”
While this sounds good in theory, when it comes to pain caused by muscles, joints and nerves in the body, it's rarely that simple.
The Body is a Complex Machine
The body is complex. Poor movement patterns and postures can create a domino effect where the source of the problem may not actually be the same as the location you are feeling pain.
To complicate the issue further, in many cases, what the radiologist sees on your diagnostic imaging may create more confusion than clarity.
Here's What I Mean...
There are all kinds of “incidental findings” in asymptomatic people.
In other words, there are many things that can be considered “abnormal” on an x-ray or MRI that are very common even among people with absolutely no pain.
These findings can include disc herniations, spinal stenosis, nerve compression, arthritis, hip and shoulder labrum tears, rotator cuff tendon tears, meniscus tears, signs of inflammation and tendonitis, and others, all of which can occur in people who deny having any related pain in these areas of the body.
And surprisingly, these types of findings are in all populations – young, old, athletic (recreational to elite level), military, musicians, dominant and non-dominant sides, etc.
See for Yourself...
The chart below summarizes the medical research showing the prevalence of "abnormal" findings among completely asymptomatic individuals:
We Can Draw Two Conclusions from this:
1) We cannot place all of our hopes and dreams on getting an X-Ray or MRI to magically solve our musculoskeletal pains. It is just a piece of the overall puzzle that may or may not be relevant to your specific pain condition.
2) Even if you have already had an x-ray or MRI that “is the worst your doctor has ever seen”, don‘t lose all hope quite yet! The great news is that a highly trained physical therapist will be able to evaluate your movements and postures to help determine whether or not those findings are relevant to your specific problem.
It is by seeing how you move your body that the source of your problem—and more importantly, the solution—will be revealed.
And that doesn’t have to include taking pain medications, getting frequent steroid injections or undergoing risky surgery!
As a Doctor of Physical Therapy, I am trained to evaluate and treat people without diagnostic test results, full-stop. I do not need radiographs or MRIs to accurately assess and treat your conditions!
While all medical diagnoses and imaging findings are respected and considered, I do not evaluate, prescribe exercises, or otherwise treat based on these findings.
Pain is complex and experienced differently by everyone. I rely primarily on a physical assessment and a detailed history to determine the most appropriate treatment for someone.
Each patient will have a different physical presentation, location, quality, and intensity of symptoms, aggravating movements, physical activity history, stage in the healing process, personality, goals, etc.
None of this can be gained from an X-ray or MRI!
~ Dr. Dallin Page
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Brinjikji, W., et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations; American Journal of Neuroradiology, April 2015, 36 (4), 811-816; DOI: https://doi.org/10.3174/ajnr.A4173