We often see patients who bring a copy of their MRI results and say, “My doctor told me that I have a herniated disc in my back”. However, MRI results also need to be correlated with the clinical findings of the physical exam. Research studies have confirmed that 70% of us have disc herniations, but do not have symptoms. It is important to have a thorough physical exam to further assess if your pain is coming from the MRI findings. We have had many patients with disc herniation on MRI, but the disc herniation is not what was triggering their pain. An indication of this situation is if you had an epidural without relief. Root causes of pain are very complicated and often have multiple components. Studies have also shown that there are many people without herniated discs that are in severe pain in the neck or back with referred pain into their arms or legs.

An MRI is a picture that is taken in one position, usually supine, where the back is not having to work and things are relaxed. Just like you can take a picture with your camera and it can look different depending on the different types of lighting, the flash, the time of day, so too, the MRI can look different in different positions and different times of day. One position might show a disc herniation compressing a nerve, another may show only a bulge without pressure on a nerve. It is important to assess strength, sensation, reflexes, and how a person is moving, then compare these findings to the MRI results. Ideally the physical exam findings support and help strengthen the diagnosis. Pain is very complicated, involving multiple sub-types of pain within the body (mechanical, inflammatory, neuropathic, neurogenic, central sensitization, neurovascular, neuromuscular to name a few). Each sub-type has specific pain qualities, and sub-types can also co-exist. The MRI can be a useful tool in helping to diagnose but it should not be the only tool used. If you are having pain and have been told that your herniated disc is causing it, just make sure that someone has also performed a comprehensive physical exam testing: movement, sensation, strength, and reflexes. This will help to confirm or refute the MRI results and this way you can truly have a CLEARER picture of what is or isn’t causing your symptoms, and have an appropriate treatment plan to address all the components to your pain.

If you aren’t sure about the cause because your pain persists, give us a call at North Jersey Physical Therapy. We will happily help you get a clearer picture and identify the root cause.

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