Why Imaging Can be Deceiving
By Kyle Dorsey, PT, DPT
Doctor of Physical Therapy
The inventions of MRI, X-rays, ultrasounds and other diagnostic tools have helped advance the medical profession and allow for almost instantaneous answers for the everyday individual who is experiencing acute or chronic pain. As a result, society has become overly dependent on imaging results, especially when it comes to treating their pain. While diagnostic imaging can be helpful for musculoskeletal aches and pains, it doesn’t always provide the most accurate answer to your source of pain.
If you look back 10-20 years ago, most of the Physical Therapy profession heavily relied on imaging results to help guide their treatment. While this is beneficial in extreme cases, most Physical Therapists today do not always rely on diagnostic imaging to help guide their treatment.
Recent studies are starting to show that just because someone has pain, doesn’t mean they have a diagnosable condition via imaging. Alternatively, we are starting to find out that just because someone has a diagnosable pathology, a meniscal or ligament tear for example, doesn’t mean they will be in pain. There are multiple emerging studies that support this narrative which is changing how we as Physical Therapists treat each of our patients.
A study conducted in 2020 by Horga et.al. looked at the knees of 115 participants. In this study all participants had asymptomatic knee pain and agreed to undergo diagnostic MRI imaging. Once the MRI’s completed, two senior musculoskeletal radiologists graded each knee based on the pathology they saw. What they found may be surprising to some. Based off the grading from each MRI, they found that of the 115 participants, 97% had some type of diagnosable “abnormality.” Of they 97%, 30% had a meniscal tear, 57% had cartilage defects, 48% had bone marrow edema, 21% had tendon lesions and 3% had a partial ACL rupture1. While this is a relatively small sample size and only looked at sedentary adults, this study is in line with what other studies show; not everyone who has a diagnosable soft tissue injury will experience pain, just like not everyone who has musculoskeletal pain will have a diagnosable soft tissue injury.
Additionally, early imaging (prior to attending Physical Therapy) can not only lead to increased health care costs, but over prescription of opioids as well.
Why are these studies important? These studies are important because it shows that pain is a very complex feeling. While pain is a very real experience it does not necessarily mean there is injury or soft tissue damage. As Physical Therapists we frequently get people that refuse to participate in their evaluation or follow up sessions until they get an MRI or diagnostic imaging. While receiving diagnostic imaging are important for possibly providing an answer to their pain, we have found that pain does not equal pathology and pathology does not equal pain. In most cases the results of a patients imaging will not dictate treatment. While there are obviously some exceptions to this statement, a majority of musculoskeletal pain does not require a diagnosis from imaging.
If you have any questions about a source of pain or any imaging results, feel free to call us and set up an appointment. You can sit down with one of our Physical Therapists for an evaluation and to answer any questions!
Kyle Dorsey, PT, DPT.
- Horga LM, Hirschmann AC, Henckel J, et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020;49(7):1099-1107. doi:10.1007/s00256-020-03394-z