MRI, CT Scan, X-rays: Is An MRI, CT scan or X-ray best for my pain?

By Dr Ken Nakamura+

Do you need an MRI?

 

Will a CT scan diagnose your problem?

 

Did your doctor not order an X-ray when you thought you needed one?

 

In this article, I reveal when you should have an MRI, CT scan and X-rays, along with which one is best for your particular problem and what to watch out for.

 

An MRI is short for Magnetic Resonance Imaging, and uses magnets and radio waves to make a digital picture of your body.  An MRI and CT scan is more sensitive than an X-ray but each can see certain parts of the body better than the other.  Sometimes an X-ray is the right image for certain ailments.

 

 See Also: 4 Best Exercises For People With Sciatica

 

A CT Scan means Computed Tomography scan. It is also known as a CAT scan or Computer Axial Tomography scan.  It uses dozens of tiny X-rays to form a digital picture of your body.

 

Question #1

 

The first question to ask yourself is: Will an MRI  or CT scan show me where my pain is? 

 

The answer is quite often no.  Here’s the problem. MRI, and CT scans can be misleading. You can take healthy volunteers without any lower back symptoms. Put them in an MRI and find many things wrong with them. A landmark study of healthy volunteers with no pain found bulges in the discs of:

 

  • 15% of 15 year olds.
  • 30% of 30 year olds
  • 60% of 60 year olds

 

These people had no pain and no symptoms of any kind, yet they had bulges in their discs. Why? There are only nerves to the outside of the disc, so the internal part of the disc can become quite damaged before you feel any pain.What you can see is not always related to pain.

 

An MRI is very sensitive but not very specific. 

“It is very rare for an MRI. to come back with the words ‘normal study,“ said Dr. Christopher DiGiovanni, a professor of orthopedics and a sports medicine specialist at Brown University. “I can’t tell you the last time I’ve seen it.” From the New York Times

 

You might then say, “Well these could be discs that will have a problem later on.” You would have a point, but follow-ups of these people found that the disc bulges actually had a protective effect and they had less chance of getting lower back pain later on.

 

 

The main message is that what you are feeling often isn’t related to what you find on an MRI, CAT scan or X-ray.

 

People with no symptoms have things show up on an MRI. On the opposite end of the spectrum people with lots of pain have MRIs which shows very little or nothing that can be causing their pain. 

 

 

Discs are notorious for this.  I have had many patients that clearly have nerve pressure on history and examination but the MRI report says there is no pressure on the nerve. So who is wrong? 

 

 

The MRI report is wrong.  Why? Discs bulge and unbulge according to the pressure you put on them. When you lie down in bed or an MRI machine the pressure on the discs is the lowest you can place on them. When you sit-up the pressure on the disc is much higher even more than when you stand.

 

See Also: The Best Exercises For Your Herniated Disc

 

The pressure on the disc from sitting prevents the nerve from moving and thus causes you pain down the leg. Incredibly, I have even had other health practitioners tell me that particular patients are likely faking their symptoms or are hypochondriacs because their MRI failed to show pressure on their nerve.

 

MRI’s need to be interpreted after a careful history and examination or your doctor could label you a faker or stressed.

 

The solution is open MRI, which allows you to get into sitting and other positions while you are being scanned. Unfortunately this type of MRI is not often used much as they are much more expensive compared to the normal MRI.  I am not aware of any that are available in downtown Toronto.

 

Despite problems with interpretation of MRI’s and CT scans, they are vitally important in helping distinguish between two different diagnoses when there is uncertainty, like between a tumor and low back pain.  However a skilled health practitioner will know the signs to look for.

Question #2

How will I know what is causing my pain then?

 

Your chiropractor or physiotherapist should take the time to take a detailed history and examination with a minimum of 15 minutes and more likely 30 minutes.

SEE ALSO: 6 Things You Should Look For In A Chiropractic Clinic: Chiropractic Clinic Best Practices

 

 

A diagnosis is made by the history and examination and not by an MRI, CT scan or even X-ray.  There is way too much reliance on medical imaging like MRI and X-rays, which has resulted in the loss of diagnostic skills as a health practitioner.

 

The skilled practitioner will have a diagnosis in mind, and two or three other alternative diagnosis even before the MRI or X-ray is performed.

 

The MRI or X-rays are done to confirm their initial diagnosis, not to make the diagnosis.

 

Question #3

Which one is better?  MRI, CT or X-ray?

 

Which one is better depends on what symptoms you have?

 

So your chiropractor has made a diagnosis for your lower back and you have been through four weeks of treatment, yet you are not getting any better. Do you ask your chiropractor to do an X-ray, CT scan or MRI?

 

  • Osteoarthritis or Wear and Tear Arthritis:  If osteoarthritis is suspected then a simple X-ray will do. In fact, in most cases of osteoarthritis you don’t even require an X-ray. An MRI and CT scan will also show this but at a huge expense, whereas a cheap X-ray will do nicely. Why would you suspect osteoarthritis? Well, when you have stiffness in the morning that gets better after a shower or about 1/2 hour after getting up in the morning.   

 

  • Disc Herniations show up best on MRI, but most of you should not have an MRI. Most people get better with the right type of exercises, like the extension exercises or the Yoga Cobra.Try these first.You should suspect a low back disc herniation when you have a hard time straightening up after sitting down for a while.   

 

  • Anterior Cruciate Tear -ACL tear or Knee Ligament Tear: An MRI is a little bit more sensitive than a health practitioner in detecting ACL tears. I would say that a chiropractor or physiotherapist that treats this everyday would more than likely approach or surpass the accuracy of an MRI. You should suspect an ACL tear when your knee feels unstable. Keep in mind with an ACL tear you often damage the cartilage and ligaments as well.   

 

  • Fractures That Don’t Show on X-rays. Many times a CT scan is best as bones show up better: With X-rays, rib fractures don’t usually show up. Most rib fractures are not treated and since you can’t see them on X-rays it’s best not to take one in the first place.  A doctor does need to make sure there was no subluxation/dislocation or puncturing of the lung.  Again a proper history and exam will tell you enough in the vast majority of cases. For other areas CT is better. With a fracture there is usually sharp pain with any movement.

 

  • Cartilage tears of the knee, hip and shoulder: These include meniscus tears of the knee, hip labral tears and shoulder labral tears. Arthrograms are best to view them. What’s that?  A dye injected into a joint  so that the cartilage shows up when an X-ray, MRI or CT scan is taken.Cartilage tears usually have a clunk/ click with sharp pain   with most movements very restricted.

 

Problems with Socialist Medicine and Capitalist Medicine.

 

With capitalist medicine when you have health insurance, doctors and care givers of all stripes want to give you all the services whether they are needed or not.  This includes MRIs, CT scans and X-rays.

 

The problem gets worse like in the US when doctors own MRI and CT scanning machines and the “labs” that they are in. This creates a conflict of interest as they need to pay for the 2 million dollar MRI.

 

With semi-socialist medicine in countries like Canada and Britain, even when you need your MRI you can’t get one. Without the MRI you can’t schedule surgery. The result, in Canada some people wait 6 months or more for an MRI of the hip and wait another year for surgery.

 

There does seem to be some improvement lately due to extra payments from the federal government to the hospitals.

 

Still, I have seen well connected patients jump the queue to get an MRI in Canada within a week.  Sports teams also jump the queue by paying for the MRI.

Dangers of an MRI

 

An MRI machine has a powerful magnet that attracts most metallic objects. Therefore the danger lies with any implants that contain iron. Your implant can move and injure you physically or heat up and even burn you. The following are implants that are unsafe for MRIs.

 

  • Older vascular stents
  • Cochlear implants
  • Brain-aneurysm clips
  • Pacemakers or cardiac defibrillators
  • Gastrointestinal cips
  • Certain medication pumps (such as insulin pumps)
  • Stainless steel spinal fusion screws and plates cause problems for the MRI and you.  However titanium screws and plates are fine.  The stainless steel causes the digital picture to be degraded.
  • Metallic objects like metal filings that have accidentally gone into the eye.

 

Gadolinium dyes are used in some MRIs, Gadolinium contrast dye is apparently safe for most of you, but unsafe and can cause death in those with bad kidneys. If you are getting a procedure with Gadolinium your medical doctor should do a screening test for your kidney function.

Dangers of CT Scans and X-rays

 

For CT scans and X-rays you should be concerned about radiation. According to the Mayo Cllinic, you are normally exposed to 2 millisieverts of radiation a year. 

 

Yes, you are exposed to radiation all the time. The radiation is all around you. The rocks, shellfish, sun, and even flying in an airplane gives you exposure to radiation. The higher you go, the less protection you get from the atmosphere above.  Similarly living at a higher altitude will give you higher levels of radiation. You get approximately 10 millisieverts if you live in Colorado.

 

 

 

 

 

  • Neck CT scan gives about 6 millisieverts of radiation or approximately 3 years worth of radiation that you would normally get.
  • Brain CT Scan gives about 2 millisieverts of radiation or approximately 1 year’s worth of radiation that you would normally get
  • Low back X-ray gives you 1.5 millisieverts of radiation or approximately 8 months worth of radiation that you would normally get.
  • Neck X-ray give you 0.2 millisieverts of radiation or approximately 1/10 worth of radiation that you would normally get in one year.
  • Mammogram gives about 0.8 millisieverts of radiation or approximately 4 months worth of radiation that you would normally get.

 

While this does sound like a lot, you have to ask yourself a few questions.

 

  1. Do you have a diagnosis that you and your health care practitioners are not sure of. If you or your doctor are not sure then you may want to get a scan
  2. Will your treatment change due to the scan? If the treatment isn’t going to change with a scan then the scan is likely not worth it. Your health care provider should know the answer to this.
  3. Is this your first CT scan or have you had multiple scans? Multiple CT scans leads to cumulative damage from radiation. You have to weigh the risk/benefit. Multiple MRIs have no known side-effects.  Then again, we weren’t sophisticated enough to stop people from taking X-rays of pregnant women in the 1960s.
  4. Are you at high risk of Cancer? e.g. your sister and mother had breast cancer or you have the gene for breast cancer or have multiple lumps.
  5. Will a scan show me where my pain is?
  • Now make a chart of risk and benefits.
  • Think about each one.
  • Talk to your health practitioner about this.

 

Tell us what you think in the comments below and like us on Facebook. This Toronto Downtown Chiropractor will answer all questions in the comments section.


Author

Dr Ken Nakamura

Who is Dr. Ken? I’m a father, spouse, chiropractor, and I love what I do! I created Bodi Empowerment to bring you and everyone-else safe and effective methods for self-treatment by basing my articles on research to everything I can. Still many parts will be based on 18 years of experience, seminars, and collaboration with other health experts; which means you will get opinions as well. Sometimes my articles won’t agree with what is currently accepted, but I am not here to please everyone. I’m here to empower you through the knowledge that I give you. Dr. Ken works at Rebalance Sports Medicine in downtown, Toronto.

100 Responses to MRI, CT Scan, X-rays: Is An MRI, CT scan or X-ray best for my pain?
  • Ashlyn says:
    May 20, 2017 at 7:44 pm

    Hello, for the past two days I’ve had these excruciating headaches. It’s more of a feeling than a pain in my head, feels like there’s a huge pressure inside the middle. Also, when I walk I feel like I’m going to lose my balance but don’t. The room isn’t spinning, there’s no blurred vision, no slurred speech, I can remember everything about myself and my birthday. There’s no pain anywhere else on my body.
    I just have this weird head pain and feeling unbalanced when I walk. I also feel nauseous but don’t throw up. I went to urgent care but they couldn’t really tell me anything, just said I might have a migraine or tension headache. My boyfriends has suggested dehydration.
    I plan on going to a real hospital because I want this to go away. But do you have any idea what this sounds like?

    • Dr Ken Nakamura says:
      May 21, 2017 at 8:45 pm

      Thanks for your question Ashlyn. Your symptoms can be related to a number of things including your inner ear, the back of your brain that controls balance, arteries that go up to your brain from your neck and lastly upper cervical problems. I can’t tell you which one as I have obviously not examined you. The above is an opinion based on the limited amount of information. I don’t recommend you keep looking up websites to determine your diagnosis as often you will think you will usually think the worst. I would go to another doctor like neurologist who can differentiate your symptoms and signs and determine your likely diagnosis before getting imaging. The doctor should spend time with you getting your history and exam.

      Imaging should only be done to confirm a diagnosis or to rule out some nasty problems. Ask your doctor what he/she is thinking of before getting imaging. If they have no idea either your problem is very uncommon or they are not doing a good job. Most doctors are really only confirming a diagnosis.

      Hope that helps your headaches? If you have any more questions for this Toronto downtown chiropractor I will do my best to give you a useful answer.

  • anil says:
    May 16, 2017 at 10:02 pm

    I have neck pain since two month…not improving… Its study .pain….two xray and one MRI showing nothing…. Worry about neck pain …could its due to cancer …like head and neck cancer or spinal cancer metastatic…..

    • Dr Ken Nakamura says:
      May 17, 2017 at 2:11 am

      Thanks for your question Anil. First, while it’s not likely you have cancer just because you have pain for two months. Cancer is excluded with a proper history. The most important questions being.
      1.If you have previous cancer. Doesn’t sound like you do, otherwise, you would have mentioned it. Correct me if I am wrong.
      2. Are you over 65 year of age? Again your writing doesn’t indicate this, but you can correct me.
      3. Weight loss for no reason
      4. Night pain so much so that you don’t sleep. You would have complained about this.

      If you didn’t answer yes to these questions the chances are you don’t have cancer. Just because you don’t have anything on MRI and X-rays doesn’t mean you have cancer. Why don’t you go to a doctor that will do a thorough history rather than someone that charges you for an MRI and X-ray. Likely a good chiropractor can help.
      This is an opinion and not a recommendation.

      Hope that helps your spine.

      • anil says:
        May 23, 2017 at 12:24 am

        Thanks ..for reply….yes I m 32….not having previous cancer….pain is light or mild….other than pain I have constant phelgm in my throat…..alrwdy visited 4 ent doc…but they think its due to post nasal dip… And gerd…
        .

        I strongly believe.. My neck pain is due to…throat problem……already.. Taken 5 day IFT swt .
        But no use….pain is light/mild
        .
        But its constant

        • Dr Ken Nakamura says:
          May 23, 2017 at 9:06 am

          Anil, if your neck pain is related to your throat pain then I cannot help as that it not my area that I deal with. I don’t deal with GERD or reflux. Sorry, I can’t help you.

          Also, while you may be frustrated at not knowing what the problem is, try not to think the worse of your situation.

  • mike thomas says:
    February 23, 2017 at 3:25 am

    Dr ken; i have chronic back pain mostly left side,it goes from hip area to lower shoulder blade,have had xrays,mri,ct scan,all which have shown nothing,have seen several docs,including rhumatologist,and pain doctor. 6mths of chiro,6mths physio,massage ,accupuncture. nothing has helped,chiro and physio both seem to make it worse. if i stand more than 10 min or sit more than 10min it starts to burn and then gets to the point where its hard to breathe and i feel like i am going to pass out.if i do the physio excersises or get chiro adjustment i am in extreme pain for about a week after. they have prescribed me naproxen,cyclobenzaprine,amitriptyline,i got no relief from any of it,i have also received multiple trigger point injections,with no success. the only relief i have found is lying on my back with heating pad and pulling my knees to my chest,however as soon as i stop i am back to square one. this all started when i was 40yrs old ,am now 52. I live in saskatoon saskatchewan. the doctors around here say there is nothing more they can do for me. I use to enjoy all kinds of physical activities,now i cant do anything without extreme pain,it has ruined my life. any advice would be very helpful. thank you

    • Dr Ken Nakamura says:
      February 23, 2017 at 11:37 am

      Thanks for your question Mike. Try reaching towards your feet while sitting. It’s like the knee to chest exercises but you are doing it while sitting.
      http://gayyoga.gn.apc.org/Article%20part%203_files/image004.jpg
      Like any exercise, it may make you worse but from what you are telling me it has a chance of making you better. You know you are getting worse if the pain increases or becomes sharp or goes further down the leg. If that happens then you should stop right away.

      This is an opinion and not a recommendation.
      Hope that helps your chronic lower back pain.

  • Gigi says:
    February 1, 2017 at 1:40 pm

    Hello, I had a cervical fusion c5 c6 on Nov 17 2015.. Im still suffering from neck pain and tingling numbness to right arm and severe pain to left side of neck.. Mri shows bulging disc on top and bottom of where fusion was done and xrays show it fused… Supposedly spine specialist says I have a great spine no other surgery required. My EMG shows nerve irritations and impinging…My lower back has impinging also. Nothing shows for surgery to be done im suffering from this pain Neck and Lower back. I also have weakness to my right side of my arm and I dont kno what Else to do. Plz Help.

    • Dr Ken Nakamura says:
      February 2, 2017 at 9:50 pm

      Thanks for your question Gigi. Unfortunately when you have fusion surgery what they don’t tell according to many patients that have had fusion surgery, is that you can have a problem above and below vertebrae that were fused. This includes disc herniations and pinched nerves. As far as I can tell this is an inevitable part of fusion surgery but it does not mean you will have symptoms. Research states that this take more than 10 years for really visible effects.

      Hopefully this fact was disclosed to you before the surgery. I am guessing though that your pain must have been severe enough to warrant surgery and that you had tried conservative treatment such as chiropractic or physiotherapy. Surgery should always be the last resort after injections are also tried.

      Also while, the surgeon says there is no need for surgery there is clear indications that the nerve is being pinched or irritated on EMG. This means that you do have a problem with the nerve that showing up objectively. As you have a fusion I am not going to give you an opinion on the type of exercises to do. However I would go find the best chiropractor or physiotherapist in your area to get some treatment done.

      Please remember this is an opinion and not a recommendation.

      Hope that helps your neck and arm pain with tingling.

  • Lauren says:
    January 2, 2017 at 4:21 am

    I need help. I had a bad chiro adjustment and it sent me straight to the ER. It was fill-in never talked to them or said two words. They applied severe sudden direct pressure to my back three times and nothing cracked. Cracked my neck and I’ve never been the same. This was 8 mos ago. I went to ER and nothing showed on xrays. I for SURE thought I broke a rib and had difficulty breathing. Tried so incredibly hard to tough it out. Sharp pain when I sneezed or picked something light up in bottom of rt shoulder blade. I have had numerous xrays, mris, been to so many drs. my dx are winging of scapula, scapular dykinesis, pain in thoracic spine, herniation of cervical intervertebral disc with radiculopathy and pain of cervical facet joint. I had three steroid epidural injections, two facet injections. I am a young female. I can lift a gallon of milk but then it flares up the pain to agony. so I cannot lift or pull things with my right arm. I drive with my left and honestly I am stuck at home now 24/7 and no social life because the pain is so bad even after 8 mos. The only option Drs. are giving me is nerve ablation but I still did not get significant relief from two facet injections maybe 30-40% relief and am told the nerve ablation will only give 10-20% for 6 mos-2 years. Facet injections only worked for about a week.. sore for a week and then a little improvement but right back to intense pain. I am forced to take pain pills otherwise I physically and mentally cannot handle the pain. Is there any way there is a muscle or tendon or ligament that is torn right on the bottom of my rt shoulder blade that wouldn’t show up on mri or xray? It literally feels like I have a knife stuck in my lower right shoulder blade. I have been having muscle spasms for 8 mos now and I am guessing that other areas are having to compensate for something that is injured and unable to heal itself. Any or all input is welcome. I need my life back. I did barbell and yoga and worked out regularly with no pain prior to this injury. My complaint to chiro was left heel pain. I am kicking myself so hard for ever going to this quack. I am hoping I can just get this figured out so the pain can go away and I can have my life back. PLEASE HELP

    • Dr Ken Nakamura says:
      January 3, 2017 at 5:14 am

      Sorry to hear about your situation Lauren. Sounds like a disc either in the neck or upper back. You need to go to someone that can treat it properly. It will take more than exercises to get you better. You should find the best chiropractor in your area or the best physiotherapist in your area. This is an opinion and not a recommendation. By the way it won’t show up on MRI as it will show as very small as you had the MRI done while lying down. Sitting increases pressure as well as standing. Don’t diagnose by MRI, you diagnose with a proper history and exam.

      Hope that helps your possible disc herniation.

  • lindian says:
    December 20, 2016 at 12:47 am

    I’ve been having neck stiffness since June and later I started having symptoms like, back pain, headache and atimes it pains me inside my head,and movement inside my head like worms, ribs started hurting me, constipation, numbness on my left leg,later it was as in I was been paralysed from my hand down to my leg, my back head and shoulders pain following hurt sensation on my stomach,I started blinking my eyes frequently all these symptoms almost at once.i keep going to hospital to complain so much later the doctor asked me to run ct scan, I did and it came out normal, I did breast and stomach scan and he said I’m OK, even neck and it OK. Till now my head hurts me inside though the movement has stopped, my neck still hurts and so many others, please what do I do?

    • Dr Ken Nakamura says:
      December 20, 2016 at 11:03 pm

      Thanks for your question Lindian. Sounds like your doctor needs to think and have an overall picture instead of head etc. I cannot help in this case as your problem is not mechanical and clearly outside of my scope of practice.

      Good luck.

  • Miguel says:
    June 28, 2016 at 3:36 am

    Hi Doctor.
    I am 50 years old. Since last year I have been having a pain in my left flank lower back region. It comes and goes. and it have been getting worst. I have been treated with anti-inflamatories (for more that 5 months now) and pain killers. At the beginning it was thought to be cause by muscle spams. I had x-ray and mri. x-ray reported grade 1 anterolisthesis of L5 over L1 due to bilateral par fractures. no compression. MInimial DDD in upper lumbar segments and mild facet OA of the two lower lumbar segments. Degenerative disk disease and facet joint osteoarthritis.
    MRI reported not pinched nerve.
    Chiropractor says he believe is pinched nerve.
    I am waiting for CT Scan.
    I have been to the chiropractor for a 5-minutes sessions eight times now.
    I went to physiotherapy a couple of times.
    I have been doing stretching and core-strengthening exercises for many months.
    If I do not take 6 500-mg of Tylenol a day the pain will be unbearable.(plus the anti-inflamatory)
    I do not know what to do next.

    Thank you.

    • Dr Ken Nakamura says:
      June 28, 2016 at 10:10 pm

      Thanks for your question Miguel. Just because there is fracture does not mean that is the cause of the pain. It doesn’t seem to correlate with your symptoms. The left flank often suggest kidney or QL muscle. I suggest getting another opinion after the CT scan as I cannot examine you and determine if it’s mechanical or not.

      Hope that helps your lower back pain.

  • Alexis says:
    May 25, 2016 at 1:26 pm

    Hi Dr.Ken! I’m 16 years old and about a year ago I started noticing discomfort in my lower back , but it has gradually gotten worse to where i can not sleep at night. I never participated in any reckless sports that would damage my back, and i have never been in any accident , but when I was 13 I started lifting heavy objects and furniture in my room to rearrange it. I done this all by myself , with no adult help. I still do so now, but have not done it in awhile because I’m experiencing pain. My pain worsens especially at night when i lay down. I constantly toss an turn in bed because I can’t stay in a certain position for a long time. Sometimes walking helps but i can not stay sitted for a long amount of time either. My first step to end this pain was going to a chiropractor. Unfortunately , nothing they did helped. They had me do muscle stimulation and I noticed that it helped a little bit but within 20 minutes , it was back to my usual pain. I decided to go to my doctor and she started prescribing me anti-inflammatory pills ( Naproxen , Methocaramol , Meloxicam ) just to name a few. None of them has done me any good. My doctor scheduled me to have a non-contrast MRI scan of my lower back and it came back “normal” for my age . I was so confused and upset that nothing showed up. I thought the MRI would show what was wrong. I do believe that the MRI might have missed something because me not being able to sleep and not being able to lay in a certain position for a few minutes does not sound normal to me. My doctor thinks I have an inflammatory problem in my back, but that leads me to ask , why are the anti-inflammatory pills she has prescribed me not targeting my pain?. I am scheduled to see a physical therapist next week for further examination but from former friendsof mine that have had lower back pain explained to me that physical therapy will just worsen my pain and bring more discomfort. II’m quite young to have these problems in my low back , and I’m just so confused about what could be causing this pain if my MRI came out normal and none of the pills I have been taking are working. My pain seems like it is still gradually getting worse. I’m starting to experience radiating pain down my legs. Mostly in my calfs and foot. It is also mostly my right leg but sometimes it is both. I shouldn’t be experiencing this at my age and I’m worried that my doctor wants to think its an inflammatory problem when it may not be the case. As you can see , I’m just so confused with everything.

    • Dr Ken Nakamura says:
      May 25, 2016 at 9:35 pm

      Thanks for your question Alexis. Technically I am supposed to say have your parents look at whatever I write. I think it’s worth it to try the physiotherapist. However you should try a referral to a rheumatologist which is a specialist that deals with arthritis, further blood work to see if you have positive rheumatoid factor and possibly a contrast MRI.

      A good physiotherapist or a good chiropractor can rule out if you have a mechanical problem vs. an inflammatory condition. However they have to be good and ethical.They have to be willing to refer you as even the best chiropractor or physiotherapist can get you better if it’s inflammatory.

      If it’s mechanical a chiropractor or physiotherapist can get you better. Unfortunately there are a lot of bad one but there are plenty of good health practitioners. It’s just a matter of finding one.

      Hope that helps your lower back.

      • Vishal says:
        June 9, 2016 at 8:13 pm

        Hi,
        Greetings of the day,
        I need your help with following situation,

        I met with an accident and then i went to the doctor. He advice for an xray but there is nothing shown up in xray. I had sever pain he write some medicine 10 days and bed rest for 1 month. After 10 days he saw me again there is little improvement . He repeat the medicine for the whole month and after a month i am able to walk. He reduce medicine and advice 1 month rest more. After that i get pretty well with little pain. He advice 15 days rest. After that i get well. When i submit these documents in my company as a medical prove their doctor said MRI is compulsory for such long period of pain. My question is my doctor treated me well or MRI was necessary despite of getting well time to time ?

        Please guide me.

        • Dr Ken Nakamura says:
          June 9, 2016 at 9:21 pm

          Thanks for your question Vishal. While bed rest seemed to get you better, you probably would have gotten better without bed rest. Bed rest has been proven by research to be not helpful for lower back pain. If a diagnosis is made and you got better there is no need for an MRI.

          The MRI they are asking is not you, they are asking because they need documentation from a workplace policy and insurance point of view. This means it’s not my area of expertise. You should ask your workplace.

          Hope that answers your MRI question.

  • Erainna Johnson says:
    April 21, 2016 at 10:12 am

    Dear Dr. Nakamura:

    I am 25 years old & I got hurt on my job back n 9/2015. I had an MRI the same day and it was normal. I had another MRI of lower back 2 wks later which results came back scaliosis. I was referred to pain mgmt Dr. which he referred me 2 a Neuro Dr. which he performed a nerve test on my legs. Neuro Dr. sent me 4 a MRI of my whole back. The results were mild degenerative disc disease. He referred me 2 an Orthopedic Dr. but I’m still having numbness, weakness & tingling from my waist down. I only have relief when I’m laying down. I can’t completely straighten my back out because it causes extreme & excruciating pain especially while trying to bend, lift and twist my body. I’m starting to experience severe neck pain when turning, tilting & lifting my head. I’m constantly loosing sleep over this situation. I’m not able 2 function on a daily basis. It has caused me the inability 2 walk or just do the basic things of caring 4 myself daily. This has gone on 2 long and I miss working. Can you please help me.

    • Dr Ken Nakamura says:
      April 21, 2016 at 10:06 pm

      Thanks for your question Erainna. It’s a long time since you worked.

      It’s better to go to the best chiropractor or physiotherapist in your area and get some rehab and exercises for your lower back in my opinion. You always do conservative care first rather than get surgery.

      You can also try these exercises. http://www.bodiempowerment.com/herniated-disc-part-2-the-best-exercises-for-your-herniated-disc/
      However you will likely make yourself worse without supervision as you likely will not be able to do the exercises without some modification. Find yourself the best physiotherapist or best chiropractor in your area.

      Hope that helps your disc herniation. The number of MRI from the information you’ve given me is inappropriate. I may be missing some information though.

  • Louis says:
    March 9, 2016 at 11:25 pm

    Dear Dr. Ken, I’m a medical student but have been having problems. I’ve had neck pain for 4 years and I’ve been taking 500 mg of Naproxen daily, which caused intestinal ulcers and now on heavy medication and risk of removing colon and having to leave med school, so I really need to find a way to fix my neck and stop the naproxen. I had a MRI and CT scan for my neck, both came clear. So it has to be a muscle spasm problem I suppose. So I did physiotherapy, massage and chinese therapy forma whole year but they didn’t help. I saw dentist, ortho, neuro and ORL and all gave me a clear. I tried narcotics, cyclobenzaprine, tridural, tylonol, TCA and none could replace the naproxen. The pain is everyday, most of the time behind the ears all the way down to the shoulder, so SCM and traps. I’m at a loss on what I should do, any ideas? Thanks!

    • Dr Ken Nakamura says:
      March 10, 2016 at 1:05 pm

      Thanks for your question Louis. First as a medical student and a university student previous to that you would have sat and studied for long periods of time. This will put a lot of pressure on your neck. MRI and CT scans are not always what you see in fact that is the rule. For example an MRI is taken while laying down you do not say but many people have pain in their neck while sitting. Sitting especially with a forward posture puts more pressure on the disc thus causing it to bulge. When you take a MRI you lay down so nothing will appear. Just because a disc is not on the MRI does not mean it’s there. Remember a diagnosis is by history and exam not by MRI. The diagnosis is formed before any MRI is taken. Unless you are lost and grasping for a possible diagnosis in difficult cases.

      That is just an example I am not saying you have a disc problem although that is a possibility. Also MRI can only detect 13% of annular tears. It’s not very good a visualizing discs. If you think about it most if not all disc herniations that have extruded should have annular tears. It would be difficult for the disc to come out otherwise. Yet very few show annular tears. MRI imaging in this regard is very poor but it’s one of the best we have. Discography is superior but invasive and I would not recommend it.

      I cannot tell you what your diagnosis is. It may be the SCM or traps as you say and simply not treated properly but it can be a myriad of other problems. You may think about trying alternatives to Naproxen. I am not an expert in this regard so a Naturopath may suggest some alternatives that may see you get off your Naproxen. Your kidney and liver may thank you for it.

      Hope that helps.

  • Brenda says:
    February 15, 2016 at 4:05 am

    For the last week and a half I wake up in the middle of the night in excruciating pain in the right side of the base of the back of my head to my neck. Nothing relieves it, not ice or heat. After having to get up and sit up for approx. 30 minutes it finally subsides. This occurs every night. Please help, what kind of doctor should I see? Would I need an X-ray, MRI or CT? Thanks for any advice you can give me. Brenda

    • Dr Ken Nakamura says:
      February 18, 2016 at 11:29 am

      Thanks for your question. Sounds like a cluster headache. Your family doctor or rheumatologist can prescribe the appropriate mediation if it is a cluster headache. Otherwise they can do more tests to determine the cause of your headaches like an MRI. \

      Hope that helps your headache.

  • Brian says:
    January 30, 2016 at 8:48 am

    Hi Dr. Ken
    I got in an accident over a year and a half ago , and I have suffered for an certain injury. it seem to be a seized or a stuck 3rd rib. I go to a physo and chiro weekly just so they can do and adjustment, then im good for 3 to 4 days than I get a stuff neck and really back headaches. This is a weekly occurrence, for the last 6 months. im kinda getting tried of it. what else could be done? I do stretches every night as physo suggested

    • Dr Ken Nakamura says:
      January 30, 2016 at 1:59 pm

      Thanks for your question Brian. So you get a stiff neck and headaches after the treatment wears out in 3 days right? Sounds like you need the right exercises. If you’ve been with the same chiro and physio for 6 months and gone to them weekly and haven’t changed your status than it’s time to make a change.

      Usually a stuck rib that keeps coming back isn’t a stuck rib or rib gone out. It’s usually a problem in the neck referring down to the upper back making the muscles along the upper back tight and causing the rib to go out. Hope that makes sense to you.

      You definitely need a new set of health practitioners. A rule of thumb is give them a month to get you better. If it’s a chronic or a complex case 2-3 months. Never 6 months. Either you are better or referred out to the appropriate health specialist like an orthopedic surgeon, rheumatologist, neuologist or neurosurgeon.

      Hope that helps your neck or rib problem.

  • James says:
    January 20, 2016 at 11:58 pm

    Hi, I was wondering whether you can give me some information.

    I’m 22 and I’ve been in chronic pain for 3 years. My symptoms include upper back pain, shoulder blade sharp pain and popping when taking a deep breath. Lower back pain, knee pain and shoulder impingement. I also experience some tingling and pins in my right foot.

    I’ve had a bone scan done which was normal. Knee xray was normal. I’ve been told that my pelvis is out of alignment and that one side was rotated. I’ve been told that I have rounded shoulders and weak quads. I’ve been told that my SI joint is high. I don’t know the source of my pain.

    I’m worried about having disc degeneration or damage to anything in my back. The problem is my symptoms are unorthodox. I don’t experience typical sciatica, just a bit of foot pins and needles. I don’t have sharp debilitating back pain either, just stiffness and strains sometimes.

    Please help me get an idea of where to start.

    • Dr Ken Nakamura says:
      January 21, 2016 at 11:20 pm

      Thanks for your question James. You could have few of the following. Arthritis like osteoarthritis, a short leg which is usually due to a pelvic misalignment, or an actual short leg after fracturing the leg or developed that way. Also you could have a flatter foot on the one side which caused the pelvis to be uneven causing pain or numbness from a pinching of the nerve in the back. Finally you could have a locally trapped nerve in the foot but that isn’t as likely.

      Hope that helps with the search for your answer. I can’t give you a more definitive answer without an history and examination in person.

  • Amy says:
    January 12, 2016 at 11:55 pm

    Hi Dr Nakamura,
    I’ll try to keep this short.
    I am 26 and I injured my lower back on October 10 of 2015 playing basketball. There was not an impact or anything, I sat on a bench for 3 minutes after playing for half an hour, leaning over my knees, and when I stood up I could feel the pain in my low back.
    The pain worsened, and over the last three months it has presented different symptoms. It was originally just low back pain, and then I started feeling Pain in my sacrum.When the sacrum pain disappeared the pain went back into my lower back. I had an xray of my pelvis done at this time which came back normal.
    I started doing hot yoga and that alleviated the pain completely for a few hours, it was amazing. Then, it got better and I went back to work on modified duties, but it was too early and only got significantly worse. This was November 10.
    It continued to hurt and the pain changed again, I now was getting a really sharp pain only on my right side about my mid level back, just to the right of my spine. This was accompanied with a burning sensation in the same area.
    On January 3 I got another xray done showing a degenerative disc, my L5S1. I am still getting the burning sensation and pain higher up my back, and in the last two weeks, it has become painful to lie down whereas before that was the only position that gave me any relief.
    I am wondering if it is worth paying for the MRI to see if there is anything else going on, as this lasted for over three months and the pain and symptoms keep changing. Also worth mentioning, in August I went to a music festival and had severe back pain from all the standing, and was getting sharp pain in my left hip / butt cheek when I walked. Since August, I have not experienced this pain again.

    Thank you so much, it is amazing to see a doctor willing to take the time to respond to people, it means a lot.

    • Dr Ken Nakamura says:
      January 15, 2016 at 1:02 am

      Thanks for your question Amy. Sound like you are having disc protrusion or a disc herniation. You don’t need an MRI to diagnose a disc herniation but may need it if your doctor suspects something more serious. You need someone that will do a thorough examination.
      If I am correct these exercises will likely help. http://www.bodiempowerment.com/herniated-disc-part-2-the-best-exercises-for-your-herniated-disc/
      If the symptoms like numbness, tingling or pain goes further down the buttock or thigh than you are getting worse and you should stop the exercises. Occassionally people can have relief in the buttock and thigh but feel more pain in the lower back. This means you are getting better.

      Hope that helps your likely disc herniation. It’s a classic disc scenario.

  • John says:
    December 25, 2015 at 2:24 am

    I had an accident at work 3 yrs ago,I have had an mri scan and it showed an old avulsion with 3mm displacement,a week later I had a ct scan and that showed normal structure with no displacement. How can the scans be different???

    • Dr Ken Nakamura says:
      December 26, 2015 at 3:30 am

      Thanks for your question John. First your doctor should be consistent and try to get the same MRI. Second, it depends on positioning. You don’t state what was imaged but the principle will be the same. If you are doing an image of a shoulder as an example you often will rotate your arm inwards, outwards and put it in neutral position. Do the picture again and go to a different place with different staff and they will position you slightly different. Your shoulder could be more rotated or less.

      That would account for the difference. A chronic avulsion after three years will not heal spontaneously.

      Hope that helps your understanding of MRI and CAT scans.

      • John says:
        December 26, 2015 at 1:53 pm

        Sorry it was my elbow. I was being treated for tennis elbow over the years and the avulaion fragment was found upon investigation because after 5 cortisone injections,prp injection and relief surgery I am no better. Mri clearly showed fragment but ct scan showed nothing. I’ve been discharged now with no explaination and no diagnosis

        • Dr Ken Nakamura says:
          January 4, 2016 at 5:51 am

          Thanks for your question John. While CAT scans are more sensitive to bones and MRI to soft tissue that’s a generalization. MRI are generally more sensitive but they both use different technologies. So yes the fragment is still there and but the CT scan just didn’t pick it up. I would go to another clinic to get another opinion. You might need surgery but therapy alone may be enough.

          Hope that helps your elbow pain.

          • John says:
            January 5, 2016 at 4:48 pm

            Thankyou for putting my mind at rest,you do a great job. Happy new year 👍👍

          • Dr Ken Nakamura says:
            January 6, 2016 at 12:14 am

            You are welcome John.

  • Karisa says:
    December 21, 2015 at 2:49 am

    My curiousity question after reading your article, is: what is the likeliness that my primary-care physician and even chiropractor ignores signs of a possible need for a MRI, CT or X-Ray? These questions come from my history, which is: In April 2005 I was struck by a car while riding a bicycle, after healing from a broken leg, between July and Aug. 2005 I went to a chiropractor for low back pain that hadnt subsided since the accident. I was treated for about 3 years on a biweekly basis by the chiropractor because I kept re-injuring my back with daily activities. Continued care was ended due to lack of insurance and moved away. I have been seen by a chiropractor when it’s completely necessary, because the pain was beyond manageable chronic. With my pain tolerance, I put up with a lot. One wrong movement it seems that my back is throbbing from top to bottom, or my hips are buckling underneath me. In July of 2010, I slipped off a cabover bunk in a camper, and slammed my back into the kitchen counter. Without being able to move with out jolts of pain, I went to the chiropractor and he assesed it as a sprain of my lower back. This was his diagnosis and how he treated me, completely based on the physical examination. Shouldn’t this have been an instance some sort of imaging tool should have been used?? Finally, just about 2 weeks ago I slipped on some ice, my feet and legs came from underneath me and 100% of the impact was flat on my back. I am now back in extreme pain and worried about how to go about gettin treatment. I’m sure that there hasn’t been any imaging of my back since the accident of 2005. I have been in nearly continuous, non-stop pain for almost 11 years. Days go by that I can’t get up from sitting with out help, and minor movement’s send shocks of pain thru my back from low to shoulder blades. The ache in my spine never goes away fully, every so often the only way to dull the pain is readjusting my position every 2 hours or less.
    I have done a lot of personal research and wonder if 10 consecutive years of pain is enough for an imaging of some sort to see of the impact injuries every 5 years has done permanent damage to my back? Countless strains from overuse, have been endured as well. Which imaging tool might be best for my situation??

    • Dr Ken Nakamura says:
      December 23, 2015 at 11:02 am

      Thanks for your question Karisa. First when you break a leg it can heal shorter than the other. This can cause imbalance in your body leading to back pain. Regarding the criteria when for X-ray, trauma is a good criteria. So yes your chiropractor or your medical doctor should be x-raying you. However the problem is it will show a lot of things wrong and doctors can be easily misled as diagnosis by imaging is quite common.

      You would normally get an X-ray first. Then if warranted an MRI.

      Sounds like you are in Canada or the UK. Since in India or the US you would have gotten imaging even when you don’t need it. In your case I would do an X-ray in your situation.

      Hope that helps your decision on X-rays etc…

  • Joshua Sofka says:
    October 29, 2015 at 8:09 pm

    Hey doc, from one thing to another i had origianlly started out with chronis ankle pains during a 2 mile run last nov 5. I seeked helped i was told not to run anymore and see how the pain goes. needless to say i had some training in feb of this year that required lifting, lots of movement which i believe didnt help. I started having knee pains in mostly my right knee then worked it way to my left knee. All in this was i found out i have severe degenerative cartilage. Which leaves me with popping and grinding in both hips and chronic back pains. I was in a wreck sept 23 was rear ended by a individual doing 70 with no intension of stopping before impact. I have taken a hand full of medicine, including prescribed narcotics and muscle relaxers and nothing is taking the pain away in my spine. I had 2 x-rays and a ct-scan with which my primary care provider said there is nothing we can do, there is no signs of anything damaged. But i cannot be hurting this bad to not have something damaged. I have sharp shooting pain like some is stabbing me, the pain is at its max when i sit down and the only way to relieve some pain is to stand up which will put me at about a 7. Most of the time my pain level is a 9. He said the ct-scan would show signs of a bulged or fractured disk, and or signs of pinching of nerves. He keeps insisting an mri is not needed and cannot provide me anymore care. When its cold my back hurts the worst also as the day progresses. When im sitting the pain is centralized in my mid section up through my shoulders and my neck. I get tingling in both arms, the right portion of my face has gone numb and feels as if someone is applying pressure to my cheek and allot of pressure. I get sharp shooting pains in both shoulders wether its walking or sitting down. When i walk the pain starts to centralize to my lower back and into the hip area. When i go home after work and lay down, the pain increases and is centralized in my mid section of my back. It does not go away which causing me to wake up 3 to 4 times a night because i cannot sleep in any comfortable postion. It is hard waking up in the morning my body is super stiff and takes slow movement to get my body goin. After doing a little research i believe i have nerve damage or damaged disks. He says the ct-scan shows everything is aligned and it looks good and i am just having muscle spasms…. i beg to differ because i can apply pressure in the pain points and its deeper than the touch to the surface muscles… hopefully you can help me with any info on what possibilites it could be.

    • Dr Ken Nakamura says:
      December 26, 2015 at 3:50 am

      Thanks for your question Joshua. First X-rays only show bones and joints and very poorly show soft tissue. CAT scans show soft tissue better but not as good as MRI. Having said that MRI still can’t see a lot. Your doctor doesn’t understand one key thing. Just because it doesn’t show on CAT scan or MRI it doesn’t mean there isn’t a problem. For example a disc herniation won’t necessarily show up on CAT scans, Why? One CAT scans aren’t that sensitive. Second You are lying down when taking a CAT scan. Everyday life entails sitting standing and bending forward all of which puts more pressure on the disc. You are lying down when getting a CAT scan.

      Most injuries during a car accident are soft tissue injuries. You cannot see most of these injuries with an MRI. Diagnosis is done by careful history and examination not by MRI, CAT scan or X-rays. They only help rule out possibilities. Only fractures and dislocations which would be obvious for most doctors without an MRI, CAT scan or X-ray are ruled out.

      You have what is called WAD III. This is a whip lash associated disorder. That means you have soft tissue injuries with nerve pinching. This happens as you sit because you increase pressure on the disc, liagaments, tendons and muscles when you sit.

      Hope that helps pain Joshua

  • Rita Rutledge says:
    October 12, 2015 at 11:27 pm

    I have a question. I fell flat on my buttocks. I had lower back surgery and I have a pin in me. That was back in 2008. As I get older, the pain gets worse. Now when working, after 3 or 4 hours, I start getting a lot of pain with back spasms. What kind of xray do I need to find out what us going on? I know I cannot get a MRI cause of the pin. I did gain some weight also.

    • Dr Ken Nakamura says:
      October 13, 2015 at 9:14 pm

      Thanks for your question Rita. First you would get an X-ray to determine if there has been movement of the pin. Also you can get a CAT scan if something is showing up on X-ray or your doctor doesn’t know what the diagnosis is. Most important is a good history and examination to actually determine the cause of the problem.

      Also you might consider a way to change your posture at work. If you are sitting a lumbar support roll may help put the arch in your back and prevent you from having as much pain.

      Hope that helps your understanding of the routes you might take. You should consult a health professional before proceeding though.

  • Misty Donald says:
    September 30, 2015 at 6:19 am

    I have been suffering from back and neck pain for years. I’ve had about 4 mri’s done on my back in the last several years, each one have came back showing spondylolisthesis, disc bulging at multiple levels, mild osteophye, foraminal stenosis, generous spinal canal, not sure what that means. But recently I’ve had severe back pain radiating into my buttocks and legs and had another mri. The mri came back “normal at every level” is this even possible that everything I had on the other mris just went away? Now my dr really thinks there is nothing wrong with me! Should I take the mri films to a neurologist to look at?

    • Dr Ken Nakamura says:
      September 30, 2015 at 9:56 am

      Thanks for your question Donald. Well either there was a mix up or a big difference of opinion. Likely that one radiologist is not detail oriented and the others are doing a decent job as spondylolisthesis doesn’t go away but disc bulging can go away. Osteophytes and foraminal stenosis are permanent unless you get surgery.

      I wouldn’t think any doctor would think there is nothing wrong with you. Keep in mind though that MRI are not a good indicator for the cause of your pain. For example 30% of 30 years old with no pain have disc herniatons. So that fact that you have a disc herniations doesn’t mean that is what is causing your pain. Even with multiple disc herniations.

      So it really is a doctor doing a thorough examination and history that will get you the diagnsosis. Did your doctor do a neurological exam. Reflexes, sensory testing and muscle testing to see which nerve trapped?

      Hope that helps your understanding of MRIs disc herniations and the correlation with pain.

  • Shelley Grigolla says:
    September 10, 2015 at 11:09 am

    Hi there Dr. Ken. I had successful cervical disk fusion, 3 through 7 in 1998 due to an earlier whiplash. I have lived complication and pain free for fifteen years until getting rear ended again in July 2014. The doctors say both the CT scan and MRI reveal nothing that could be causing me such debilitating pain one year later. No nerve block test was done to rule out facet damage. They still can feel that is swollen, red, and hot to the touch, but insist there is no nerve or disk damage. I suffer daily with headaches, pain radiating down into shoulder blades and when I press on neck and shoulder it is very tender. If I suddenly, quickly move my neck, and even when I laugh, I will get sharp muscle spasms. My ear and jaw are also hurting and has locked on me several times. Often when I’m chewing, I can hear a crunching in my ear. How is it that I could be in such pain one year post whiplash if it was only a muscle sprain?? Is there no hope for me, I’m only sixty two and can’t imagine having to live with this level of pain. Thank you so much! Shelley

    • Dr Ken Nakamura says:
      September 11, 2015 at 2:01 am

      Thanks for your question Shelley. I haven’t examined you but I would explore steroid injections and anti-inflammatories directed by your medical doctor or perhaps a different doctor. The redness, swelling and heat indicate inflammation. That’s very clear.

      Hope that helps your neck pain.

  • folarin kazeem says:
    July 13, 2015 at 12:26 pm

    Ii always feel unconfortable on my two legs just like some things run on and off on my blood.stream on both legs and its feels hot atimes when the weather is hot causing these these unconfortableness of putting on trousers feels like hell just like sometin is boiling and making my legs weak

    • Dr Ken Nakamura says:
      July 14, 2015 at 11:43 am

      Thanks for your comment Folarin. Hope it gets better. It can be too many things. You really should be looked at by someone that can examine you. The comments section of this chiropractor in the MRI article is not the place for you.

      Hope you get some help for your legs.

  • Mary says:
    July 9, 2015 at 10:41 am

    I had a whiplash-like injury while running on a treadmill about a year ago that left me with constant left-sided neck pain that travels to my jaw and head, dizziness, blurred vision and a distended left jugular. I only find comfort when lying flat on my back on a hard surface.

    A cervical MRI showed minor disc bulges, which didn’t seem to concern my doctor. A brain MRI and MRA came back clear. A month of physical therapy improved some neck mobility but none of the pain.

    Now my doctor has ordered a CT scan on the neck. Is there a better test? No one seems to know what they should be looking for. Despite desperately wanting to diagnose this pain I’d prefer some educated guesses before more testing.

    Thank you for this website and all you do to help people!

    • Dr Ken Nakamura says:
      July 10, 2015 at 9:58 am

      Thanks for your question Mary. It’s not a matter of a better test it’s a matter of finding a better therapist from my point of view. Go by reviews and referrals and find the best people in your area. Sound like the problem stems from the neck caused by nerve root irritation along with muscle and ligament damage. Also sounds like you have the jugular vein damage so it would be prudent to get a referral to a vascular surgeon. If there is vascular damage your vascular surgeon will probably send you for tests involving radioactive dye injected into your vein.

      It’s not one thing causing your problem, it’s a constellation that were damaged in the accident.

      Hope that helps your problems.

      • Mary says:
        July 10, 2015 at 10:20 am

        Thank you for your response and suggestions! The worst part of this process truly has been going to specialists, waiting months for an appointment only to have them say they can’t help. I’m very optimistic therapy will help given the proper regimen. I just worry about how long this has persisted with no improvement and what that means for my treatment.

        • Dr Ken Nakamura says:
          July 10, 2015 at 11:15 am

          Thanks for the comment Mary. Sound like you are in the UK or Canada. While it’s better to get treated earlier it shouldn’t delay you too much. With any vein damage, if there is any damage to the vein I don’t know the prognosis.

          Let’s put it this way. When people get in car accidents when they are significant enough it takes months and sometimes years to get better. You sound like you it hit your neck or head very hard.

          You’ll have to be patient.

          Hope that helps your whiplash injury. ( no more MRI or CT scans needed for now)

    • Gejapathy says:
      November 16, 2016 at 1:56 pm

      Hi Dr Nakamura,
      I had a whiplash accident at work.
      I was sent for a MRI by my spine specialist and will have my 1st physio this week after a month of resting at home and doing my own manual neck exercises at home.
      C3-C4 mild disc osteophyte complex indenting the thecal sac. Severe right and mild left exit foraminal stenosis due to facet osteoarthritis compounded by uncovertebral hypertrophy is noted
      C4-C5 disc osteophyte complex just abutting the cord. Moderate left and mild right exit foraminal stenosis due to uncovertebral hypertrophy and facet osteoarthritis is noted
      C5-C6 there is disc osteophyte complex indenting the cord. Bilateral moderate exit foraminal stenosis due to uncovertebral hypertrophy is noted
      C6-C7 Disc osteophyte complex indenting the thecal sac. Bilateral moderate exit foraminal stenosis due to uncovertebral hypertrophy is noted.
      C7-T1 mild disc osteophyte complex indenting the thecal sac. The exit foraminal are patent
      The spinal cord is normal in configuration and signal intensity
      The paravertebral structures are unremarkable.
      Conclusion
      Multi-level degenerative disc disease is observed. This is worst at C5-C6 where the disc osteophyte indents the cord but there is no evidence of cord odema or myelomalacia

      • Dr Ken Nakamura says:
        November 17, 2016 at 11:32 am

        Thanks for your comment Gejapathy. Your MRI report indicates that you have wear and tear or osteoarthritis that has taken decades to develop. Nothing visible on the MRI from the accident or whiplash.

        Hope that helps your interpret your MRI.

  • April Overmier says:
    June 4, 2015 at 6:34 pm

    Hi I’m April.. I have been dealing with pain in my lower back for many years. It gets worse when I do anything for a certain amount of time.like standing or sitting, laying to long. Usually within about 10 minutes and I have to adjust or do something else. I do have pain shoots down front of left leg only occasionally, numbness and tingling in toes. I am constantly adjusting. It’s frustrating. I’ve done physical therapy, epidurals with no improvement. I’ve had mri which my doctor says it just shows minimum degeneration. He says that a lot, like I’m making it up. It’s frustrating. Why would anybody pay that amount of money and making it up. I don’t know what to do. Any advice?

    • Dr Ken Nakamura says:
      June 4, 2015 at 9:34 pm

      Thanks for your question April. The last thing a doctor should rely upon is imaging like MRI, CT scans and X-rays. They have no correlation to pain by itself. That’s proven by research. I would consider a different doctor if he/she is basing his doubt on the MRI. (I don’t if that is true or not) You have to get someone that will do a thorough exam and history. For example minimal degeneration also coincides with disc bulges and disc protrusion. MRI aren’t that great yet. All they can tell is when they bulge, they miss the damage in the disc most of the time, in fact they catch disc damage approximately 12% of the time according to the literature.

      When you sit and stand there is more pressure on the disc. You take and MRI when you lie down. The disc can bulge while you are sitting but disappear when you lie down and get your MRI. So if your doctor looks at the report and says you only have “minimal degeneration” than it seems your doctor is missing a lot.

      Remember that is an example I gave you. I am not saying that is your diagnosis.

      Hope that helps your understanding and how unreliable MRI and CAT scans and X-rays can be when solely relied upon.

      • April Overmier says:
        June 5, 2015 at 8:00 pm

        Thank you so much for response. I do have disc protrusion, my Mri showed that also, but once again he says minimal. I appreciate your feedback. I may have to just find a new Dr. Thanks again.

  • Tammy says:
    May 13, 2015 at 12:43 am

    I had a car accident which caused me neck pain, almost immediately after, I went to the hospital the next day and had an x-ray, this showed there was something so they put a collar on me and sent me for a CT scan immediately, the CT scan showed “subtle impaction fracture in the superior endplate of C4”. About 6 weeks later I went for an MRI, the report indicates no impaction fracture. I have been in physio since the beginning and I’m taking Naproxen and Cyclobenzaprine, I am still very tender with limited range of motion, some pain from my shoulder blade down my right arm and tingling, this tends to happen when I’m sitting or driving usually. The C4 vertebrea is very tender to the touch, as my RMT found out recently, after lightly touching that area I suffered with pain for a few days. Which report would be more accurate with the impaction fracture statements the CT or MRI? Would treatment be different for an impaction fracture versus non impaction fracture?

    • Dr Ken Nakamura says:
      May 13, 2015 at 7:00 am

      Thanks for your question Tammy. Keep in mind there are more modern and older versions of MRI and CT scans. As a general rule CT are better at “seeing” bone while MRI is better at “seeing” soft tissue especially discs. Both are very far from being perfect. For example when a surgeon looks at an MRI than after actually does a disc surgery the actual condition of the disc can be quite different. Only 12 % of annular tears are shown on MRI but are found during surgery.

      So just because it didn’t show up on MRI doesn’t mean you healed. It means the MRI didn’t see it. I am sure your medical doctor or physio explained this to you, no? Often with an impaction fracture this causes the endplates (cartiladge) or the top of the vertebrae to break letting the contents of the disc to move into the vertebrae. This is sometimes called a vertical disc herniation as it mimics the symptoms of a regular disc herniation.

      Try these exercises. http://www.bodiempowerment.com/cervical-disc-herniation-best-exercises-help-sore-neck/
      These exercises must be done supervised or you will can get worse.

      Hope that helps your impaction fracture.

  • sudhir roy says:
    May 12, 2015 at 11:01 pm

    I am feeling pain in my both legs during 3 months sometimes when I walk about 1and 2km i am feeling very fast pain in my both legs . when I wake up in morning I feels very huge pain

  • jim rogers says:
    March 29, 2015 at 1:58 am

    I had 2 spinal fusions at my lower back after my second operation my first ct-scan my doctor never saw that a screw has gone through my vertebrae i just had my second ct-scan i looked at my second disc and i can see the screw that went through my vertebrae i believe that is causing
    my pain in my legs i go see my doctor in a few days
    cat scan shows screw through my vertebrae how could a doctor missed this and not seen this
    on the first c-scan

    • Dr Ken Nakamura says:
      March 30, 2015 at 3:55 am

      Thanks for your question Jim. It’s not possible to tell if the screw is causing you pain without looking at the CT scan. Even then without examining you I wouldn’t be able to correlate the two. It’s pretty hard to miss a screw but that doesn’t mean it’s causing pain.

      Instead of assigning blame I would concentrate on what you can do going forward. Unfortunately as I can’t tell what is causing the pain I can’t recommend any exercises. Why don’t you try the opinion of a neurologist recommended by your family doctor so you get an opinion that is unbiased. Recommendations from your surgeon will likely be someone he/she knows and will not want to contradict them.

      Hope that helps your fusion surgery.

  • Natasha says:
    March 23, 2015 at 4:15 am

    I stumbled across this forum looking for answers as I have so many times. I slipped on ice in early 2011 and have been in a significant amount of pain. Some days it brings me to tears and some days it is manageable. I have been to three physical therapists, a chiropractor regularly ( this provides temporary relief), an ortho, and family practitioners.
    I always feel some degree of pain in my neck. This often leads to pain in my shoulders, upper back, and can cause intense headaches. I have had x-rays and an MRI (lying down). I have been told everything ranging from.. Nothing is wrong, degeneration in my cervical spine, and myofascial pain syndrome. Pain medication helps but due to having to work, it’s something I can only take at night and that is if I have it available as most physicians are reluctant to prescribe.
    What step do I take next? Everything thus far (massage, pt, chiro) has helped a small amount, but I’m still in significant daily pain. Thank you!

    • Dr Ken Nakamura says:
      March 23, 2015 at 9:24 am

      Thanks for your question Natasha.

      Your diagnosis is not clear. However many cervical disc herniations can give you all those symptoms and is directly related to degenerative disc disease. You can try these exercises.
      http://www.bodiempowerment.com/cervical-disc-herniation-best-exercises-help-sore-neck/

      However there are no guarantees. It may or may not be your diagnosis. I am here to give you educational advice only. If you want a diagnosis you need to see another specialist as I cannot give you a diagnosis over the intenet.

      If the pain gets worse with the exercises or increases symptoms further down the shoulder or upper back or into the headaches including, numbness, tinging, pins & needles or pain then you should stop and seek professional help nearby.

      Hope that helps your possible cervical disc herniation.

      • Natasha says:
        April 21, 2015 at 4:39 am

        Thank you. Would you recommend anything else as far imaging? Like I mentioned before, I have had xrays and an MRI. Is there another option that may provide better answers?

        • Dr Ken Nakamura says:
          April 21, 2015 at 9:27 pm

          Thanks for your question Natasha. MRI is the best that you can get. There are different setting off course like T2 which sees the water content in your disc. This is a normal procedure so most likely was done. Also the latest MRI might provide better resolution but you have to keep in mind even if gets a lot better you are not seeing what is true. MRI takes images while you are lying down. Most people with a disc problem have problems when sitting, standing or lifting at which time there is more pressure on the disc and thus more pinching of the nerve. Most MRI only provide images of you lying down. It’s doesn’t reflect what you do in everyday life.

          I woudn’t get another MRI as it won’t provide any more information. A good health practitioner is more important.

          Hope that helps your disc herniations.

  • Anthony Becker says:
    February 19, 2015 at 1:30 pm

    Hi Dr.Ken,
    Hoping you can help me.
    I have a comminuted proximal humerus fracture to my right shoulder after falling heavily off my motorbike last August 20, 2014.
    The second X-ray was taken on 3rd Nov reporting new bone growth evidence,but as yet a complete union of the fracture site..with fracture lucencies persisting.

    The latest Radiographer reports of a Malunion?..with bony irregularity of greater tuberosity..but when I went to see the Orthopaedic Dr today he said after glancing at this X-ray..that the bone was healed fine and that I could return to work.

    Whose report do I believe..?or should I get a second opinion..or perhaps an MRI or CT scan to confirm the true status of my fracture.

    Thank you Dr. Ken

    • Dr Ken Nakamura says:
      February 19, 2015 at 11:57 pm

      Thanks for your question Anthony. Either the orthopedic surgeon didn’t look carefully at the X-ray or didn’t read the report. Malunion is serious. Go to another orthpedic surgeon to get surgery again. I would just move on. If the surgeon can’t see or can’t read it or simply is trying push you away as the surgery was unsuccessful we don’t know.

      Many times the surgeon just did their best but the bone moved or surgery was very complex and the bones in many pieces in which case the arm often doesn’t heal.

      Hope that helps.

  • Cathy says:
    February 9, 2015 at 7:55 pm

    Dr.Ken,
    Reading your comments..I like to use holistic methods as much as possible.I am stuck.I am in constant pain in my lower back across the back area .around and below the hip line .I was given an antiinflammatory medicine but it did not help I have had an xray done nothing noted that’s causing pain .was thinking of going to a neurologist as my next step.I bought a heat patch for my back and that relieves the pain slightly.please any suggestions greatly appreciated.Thank you!

  • Anna says:
    January 13, 2015 at 2:03 am

    Hi. I have a line of pain all the way down the back of left leg. I have had sciatica before and this is different. I have delt with this for over a yr now. It is worse after standing or excercising or if I don’t get enough sleep. Pretty much constant other although some relief. Left knee also clicks a and hurts. About 6 wks ago I started having pain from groin down to left knee and pain in heel. Diagnosed as planter fasciitis. I have recently had hip xray, leg xray, leg mri. All were normal. I cannot go on like this. Dr gave cortisone injection in heel (which hasn’t helped much) and a night splint. Nothing for leg though. Any suggestions??? Thanks

    • Dr Ken Nakamura says:
      January 13, 2015 at 10:32 am

      Thanks for your question Anna. It can be disc herniation or stenosis or spondylolisthesis. The diagnosis of plantar fasciitis is clearly wrong. You don’t get pain from the groin to the heel and call it plantar fasciitis. You clearly need a new doctor.

      I recommend you seek a second opinion as exercises at this point may aggravate you.

      Hope that helps your sciatica.

  • marilyn says:
    November 15, 2014 at 11:34 pm

    Hi, I have this sharp pain on my left side under my rib which radiates to lower back and numbness in abdomen and legs . Xrays and ultrasound are clear what could this be its really painful

    • Dr Ken Nakamura says:
      November 16, 2014 at 10:39 am

      Thanks for your question Marilyn. You have a more complicated picture. I recommend you see your medical doctor as I cannot examine you or take a full history which will take a while.

  • Linda Houssein says:
    October 7, 2014 at 12:00 pm

    I am a bodybuilder with an l5 fracture and herniated disc. I am awaiting a visit with a neurosurgeon for the first time on the 17th. Im not in constant pain but all it takes sometimes is getting out of a chair and I’m in pain for the rest of the week. It seems I then am crooked can’t straighten up after sitting and my pelvis and poster is hunched footwork ad to the right. I was told by my reg md that it is best is keep up the workouts to some degree in order to build my muscles for support. My question is can I still train? I need to be able to stress my muscles in order to the build and mold them. I can’t wear heels for long periods of time but I have a show coming up amd will need to. Will this end up hurting me worse? I am scared that I may be one squat away from hurting myself permanently. Is there anything I can do for building muscle in my lower back safely? Thanks!

    • Dr Ken Nakamura says:
      October 7, 2014 at 10:35 pm

      Thanks for your question Linda. You want your vertebrae that is fractured to heal properly before doing any exercises. If you had a fractured arm you can’t do light exercises to increase the muscle strength, until the bone is strong enough. Similarly you need to wait until the L5 fracture is healed enough.

      Your competition should be secondary if you want to compete again in the future, in my opinion.

      Hope that helps your L5 fracture and herniated disc.

  • Timothy Howle says:
    October 1, 2014 at 6:58 am

    Yes my 15 year old daughter was in an automobile accident a little over a month ago. She is having severe pain off and on all day on left side of neck and it radiates to her left top of shoulder. She has been on muscle relaxers and pain meds for a little over a month now with no relief. They did xray ct scan and MRI but nothing shows up. Its to the point she can’t hardly sleep at night and has already missed 11 days of school. I can feel the swelling on the left side of her neck. What should we do. It is frustrating watching her go through this pain after all the medication physical therapy and no relief.

    • Dr Ken Nakamura says:
      October 1, 2014 at 9:33 am

      Thanks for your question Tim. Sounds like your daughter is in a lot of pain and that you care for her dearly, like most parents. When you get in a car accident it damages the ligaments, tendons, disc and muscles in the neck and sometimes even the bones. Sounds like the bones weren’t affected otherwise they would show up on the MRI. The swelling can be a muscle spasm or actual inflammation that is still on-going. If it is inflammation you should keep putting ice on it especially if it is red and swollen. The more likely scenario is that there is a muscle spasm from the damage done to the muscle possibly due to a tear. (A lot of things don’t show up on X-rays).

      Also there is the possibility of a disc protrusion or herniation. The reason is the MRI are done while laying down, which puts the least amount of pressure on the disc. Well life involves sitting and usually bending forward when we are looking at the compute screen. There is simply more pressure when you do these things and the disc will stick out more. The MRI simply won’t see it because she isn’t sitting while doing an MRI or sitting with her neck bent forward.

      The first thing I would do is get another opinion and go to a doctor that doesn’t depend only on MRI etc.. first make a clinical diagnosis then use the MRI and X-rays etc.. that is already there to confirm things.

      If you get the right diagnosis it is easier to treat and get results. A disc herniation treatment is different from a muscle spassm treatment which is also different from a tear.

      Hope that helps your daughter’s neck pain.

  • Bruce ramgoolie says:
    September 12, 2014 at 11:47 am

    Hello,
    My mother has an exposed nerve in her lower back close to the spine. It’s causing her severe pain all the time. She has been going to a specialist where they have been giving her aseries of needles. They now say that some spinal fluid is leeking. One Dr. Said surgery is not needed. Another said she may have too.????

    • Dr Ken Nakamura says:
      September 12, 2014 at 5:58 pm

      Thanks for your comment Bruce. Do you mean she has an open wound when you say she has an “exposed nerve” causing the spinal fluid to leek. If she does it’s most important to prevent infection first. Exercises are secondary. This is outside my scope so I have not examined her so it’s not possible to say if she needs surgery or not.

      Hope your mother recovers soon.

  • Lucy Micallef says:
    July 23, 2014 at 9:48 pm

    Dear Dr Ken
    I am reading your comments about back pain. I have been having pain during the night only since last December in my right leg mostly from my top right limb to my ankle and going up to my knees. Lately I have become worse and had paid during the day too and I stopped practically all activity. Now I went to a chiropractor and he did some stretches etc. He thinks that it is L2 and L3 problem when he saw the X ray. I am better and now my pain during the night is less severe. Now the paid moved upwards just behind my knee and discomfort on my buttocks. I am doing exercises putting my legs up right and left and when sitting down putting my back arch more to the front. Should I do more exercises that you suggested above like the cat? In the morning sometimes I am bad but then release by time. It is worse during the night and I could not sleep properly.
    Thanks for your concern.
    Regards
    Lucy

    • Dr Ken Nakamura says:
      July 26, 2014 at 10:32 pm

      Thanks for your comments Lucy. Since the chiropractic treatments and exercises are currently working I think you should stick with that person. If they stop working or you plateau for a while you can do the exercises outlined here. http://www.bodiempowerment.com/sciatica-4-best-exercises/ Providing the diagnosis is correct

      I am not sure the you have sciatica related to the lower back from the description of your pain. If is it related to sciatica from the lower back and it is a disc that is going backwards than the exercises in link above are appropriate.

      Hope that helps your leg pain / sciatica.

  • Autumn Wilson Woodall says:
    April 19, 2014 at 2:38 am

    Hi, I am Autumn. My husband has had back surgery for a crushed disc at the L5S1 area. He is almost 8 months post surgery and still has severe pain down both legs making it difficult to walk or stand for long periods. He has pain and tingling and loss of balance. He is still have spasms up and down his back. The Dr has done both MRI and CT and said that they were normal. What do you think we migt need to do for him. The Dr said this is as good as he will get…

    • Dr Ken Nakamura says:
      April 19, 2014 at 5:16 am

      Thanks for your question Autumn. Surgery should usually help but if it didn’t then that is a very bad sign. Having said that there may be more minor goals that are attainable but definitely not guaranteed.

      Try doing these exercises except for the sphinx and cobra and standing extensions. If he gets sharp pain, more pain while doing the exercises or pain for more than 10 minutes after doing the exercises than the exercises are not for him.
      http://www.bodiempowerment.com/herniated-disc-part-2-the-best-exercises-for-your-herniated-disc/
      The goal in his case would be to get him to stand 10 minutes longer or sit a little longer before the pain gets worse.

      Also get a second opinion from a neurologist not a neurosurgeon. This way there is no conflict of interest as neurologists cannot do surgery so can only recommend someone else.

      Hope that helps your husband’s disc.

  • James Maxey says:
    March 7, 2014 at 9:58 pm

    I have pain radiating down my leg into my foot. I was diagnose with a large os trigonum in my right ankle yet the doctor said it was a normal right foot. A Os trigonum is a small round bone posterior to the talus. So how can a large Os triginum be normal? I have sclerosis bilaterally in my sacroiliac joint. What should be the diagnosis?

    • Dr Ken Nakamura says:
      March 8, 2014 at 10:08 am

      Thanks for your comment James. Your concern is that the since the Os Trigonum is large, to you it doesn’t sound like the foot is normal even though your doctor says its normal and the X-ray report likely says it is normal.

      The problem when the OS Trigonum is large is that it can get pinched between your ankle and heel bones. Usually the pain is triggered by walking, jumping and pointing your toes down. You can try treating it by doing trigger point work on the leg (calf).

      Trigger points is simply pushing on a muscle with your thumb and finger on a sore spot on your muscle for about 10 seconds. So you simply push hard on calf muscle where it sore from your achilles all the way up to the knee joint. Work your way up in rows until you treat the whole muscle. When you come across a particularly painful and sore spot push for a longer period of time until it starts to feel better.

      Warning: you shouldn’t do this if you have any of the following like Diabetes, previous high cholesterol, previous stroke, heart attack, high blood pressure and smoke a lot. The reason is you can dislodge a clot if you are susceptible to clots (those that have the above symptoms are more likely to have leg clots). Leg clots can be dislodged and cause a stroke.

      If your pain actually feels likes it comes from higher up in your leg and radiates down than you need to get your lower back examined.

      Hope that helps.

  • David says:
    March 5, 2014 at 10:55 am

    Hello I have been having extreme pain in my shoulder neck and head areas. Only ever in the right side. I have constent pain along with pain spikes that cause me to blackout due to the pain. I have had no luck getting any help at all. I am wondering if a mri or other scan will help show any possible problems. And what scan would be best for the upper back into the head. To show the most details and everything to hopefuly find out the cause to this long term extreme pain problem. I have the current option for a mri even tho I can barely afford it. So I want to find out if this will help pin point a possable cause to the extreme pains. Or be yet another great waste of money and time. Any help or thoughts at all would be great. If possible please reply via email. Thank you

    • Dr Ken Nakamura says:
      March 5, 2014 at 5:14 pm

      Thanks for your comment David. Can you explain where your pains are in your shoulder neck and head.

      For example the pain might start on the right side of your neck and spread to your shoulder and upper arm and the back of your head or your pain might start at the top of your head spread down to your neck and eventually your upper back near your shoulder blade. What makes it worse, better? Does it the pain go radiate into the shoulder and into the hand? Give me more details.

      My job is not to diagnose you but give you a possible idea as to which machine can possibly help you.

      Waiting for your reply.

      • David says:
        March 5, 2014 at 11:10 pm

        Thank you so much for your reply and help. The pains started about 5 years ago acting like a migrain with extreme pain in the right side of the head like a extreme migrain. And over the years has spread to include my whole right side from botom of shoulder blade threw the head. I am in constent pain in my neck and shoulder right side only. That pain is best described as a ice pick attached to a clamp squezzing down on certain points. In the upper shoulder area or any section of the spine from that point up threw the atlas, axis, and skull opening for the spine. Nothing seems to trigger the pain it jus comes and gose as it pleases. And very little will help ease the pain. Now this pain dose get way wors genraly when the pain spikes happen its in the upper shoulder, neck area. Or the base of my skull around the atlas, axis, base of skull. This pain starts out as a similar pain as stated earlyr. But quickly gets way wors filling like the most undescribale pain I could ever imagen. Which quickly spreads from which ever starting point threw to include the whole right side only. From mid, lower back up threw the entire head. The pains will cause a simulated but much wors migrain pain in the head which causes right eyes light sinsativatie. Excess tear production, excess mucus production which tends to clog my sinius adding sinius pains. I have to contiuly try to force open my eye to release the tear build up aswell as force clear my sinius to relieve that pressure pain. Whenever I can get a basic control of a pain spike or get my sinius cleared in the process. The pains grow more extreme and undescriable until a point I blackout from it. When I blackout I go from unconfortably moven around in pain trying to find a postion to relieve it. To waken up 2-4 hours later genraly startled awake by a noise or sumthing touching me like a pet. I do not lose control over bladder or bowels when blacked out. I seem to simply blackout from the pains to wake up few short hours later. When I do come to again I genraly either fill extremely tired and am able to go to sleep for a few hours. Sometimes waking up in pain again sometimes not. Or sometimes ill wake up filling somewhat rested and ready to go again with only genral disconfort or pain. All the disconfort and extreme undescribale pains are only ever in my right side almost perfectly down the center of my spine. And there has only ben 2 times which the pains crossed that line to include my left side. Both times it started out the same as described above but quickly taraveld across my upper back and neck to include the left side. When that happened both times it spread up into my head to include a extreme migrain filling. Aswell it traveled down my back and arms to make them fill extreme pains mixed with numbness and tingling. And would cause my hands to lock up in pain aswell balling up in a weird manner, not a full balled up fist as sum fingers did not cruel up. Those 2 pain sessions where by far the wors and scarest but only lasted 30-45 mins and happend 3 years apart the last one being about a year ago. The other described undescriable pain sessions last anywhere from 30mins to a full day or more. The wors being 4 days unable to sleep more than a hour due to the pains and no more than a half hour at a time where the pains where not near blackout levels with 5 blackouts in the 4 day stretch and that was about a year n half ago. I am afraid I can’t give you much true medical answers as I have not recived any attion or help as much as I have tryed to get it. And have had to start reserching and trying to figure things out on my own. When I found your very helpful site and desided its worth a shot to ask for sum knowlage n help. I am looking foward to your next reply and help, knowlage. And will contiue to give you all the info I can that will better help you out in helping me a little. Thank you so much for your help kind sir.

        • Dr Ken Nakamura says:
          March 6, 2014 at 8:45 am

          Your pain could be related to your neck or your head. Really your pains are too complex without an examination. You should seek out a professional health care worker. I would consider a neurologist due to the nature of your pain. After five years it is possible that it is a neck problem that has centralized. Meaning that having so much pain for so long changes your nervous system so that very little provocation gives you extreme pain.

          Please seek out proper professional care in your area as your case requires hands on examination. I wish you the best of luck.

          • David says:
            March 6, 2014 at 9:37 am

            Well honestly the only reason this has gone on this long. Is due to not being able to get proper attion and care all this time. The only thing I can do is keep trying, armed with this new helpful knowlage you have provided me. Thank you so much for you fast respones, intrest, knowlage, and careing. You are a good man keep up the good work.

  • William says:
    November 27, 2013 at 1:43 pm

    Thanks Dr. Ken for introducing such an effective method of self treatment for us and hope that you will bring more effective way for us in near future as well. So will look forward once again to see your next update and hopefully that will be more excitement. Really appreciate able!

    • Dr Ken Nakamura says:
      January 16, 2014 at 10:18 am

      You are welcome William. Since you are commenting about the MRI article, I want to remind you to make sure you actually need an X-ray or MRI. Many doctors including chiropractors feel pressured to give X-rays and MRI when either the patient demands it, when a patient isn’t getting better (not a bad reason), or they want to pay for the MRI or X-ray machine that they bought. An X-ray machine can now run $100 000 -$200 000 while an MRI can cost $2 million dollars. Just make sure they are following the criteria outlined in the article.

      • Seth says:
        February 25, 2014 at 2:02 pm

        hi doc is it true that some doctors and ragiologist are not able to read xray reports correctly

        • Dr Ken Nakamura says:
          February 26, 2014 at 9:32 am

          Thanks for the comment Seth. General practitioners and family doctors are trained during medical school to read x-rays, CT and MRI scans. During residency (internships) there is usually further education. However at least in Canada most family doctors come to rely on the reports made by radiologists and don’t even look at X-rays. Those doctors that also work in hospitals may be an exception. My guess is, that the US is similar. For Europe I think it varies according to country.

          So if a family doctor doesn’t read a X-ray or MRI for 10 years they are not very good at it. Radiologist on the other hand read X-rays and MRIs everyday so are generally good at it.

          Even with experienced radiologist you can get X-rays, MRI reports that have missed, sometimes obvious problems. There probably many reasons for this ranging from competency, boredom, senility for the soon to be retired radiologists. In other words they are human and make errors sometimes. To avoid this you can always have an MRI or CT Scan or X-ray re-read by another radiologist for a second opinion or a chiropractic radiology specialist with the designation “DACBAR”.

          Hope That Helps.

          • Rodolfo Garcia says:
            July 27, 2016 at 1:35 am

            Dr. Ken hello how’s it going My name is Rodolfo i am 20 years old and i have been having pain on my lower mastoid bone and goes down the side of my neck for about 2 years now, i had an ultrasound performed on that side of my neck and the doctor could not find anything, said everything looked normal. The pain persisted so about a week ago i had an xray of my mastoid performed and the doctor told me everything looked normal again but still the pain persists. I am going crazy with this pain , i notice the pain kind of subsides when i lay down or stretch my neck. Pain increases when im standing. The doctor has ordered a ct scan but i dont really want to expose myself to so much radiation. My main concern is tumors and cancer . Im so scared sir, but my doctor insists its most likely due to a bad muscle on the side of my neck. I don’t know what to do anymore i really dont want a ct scan i rather get an MRI but im not sure if it will show anything. What is your best advice doctor i am so scared i am only 20 years old and i can’t live my normal life. I stopped the gym, i can’t concentrate in school, i can’t work normally without thinking of the pain. I feel horrible please give me some advice.

          • Dr Ken Nakamura says:
            July 29, 2016 at 9:08 am

            Thanks for your question Rodolfo. First as you know by now ultrasounds and X-rays, MRI and CAT scans even when they find things it often doesn’t correlate with the pain. You need to go to a good chiropractor or good physiotherapist or an osteopath or even a massage therapist. They are trained to look at muscles, bones, nerves, ligaments and schooled in how to treat those conditions. A medical doctor is trained to diagnose those things but not treat them. They can recommend medication or refer and unless they are a specialist. A specialist like a physiatrist is a medical doctor trained to treat these conditions. Orthopedic surgeons generally do not treat manually, usually sticking to medication, injections or surgery.

            The general rule is that you use conservative treatment like physiotherapy, chiropractic or osteopaths first. If that doesn’t work use injections and medications.

            You haven’t tried conservative treatment unless you left that part out. That’s an important first step to diagnosing and getting things better.

            Hope that helps your neck (mastoid area) pain. Keep in mind the sternocleidomastoid and longissumus capitus muscles attach to the mastoid. Usually you treat the muscle the pain goes away. With person like yourself it will likely take longer as you are focussed on the pain and thinking the worst. Most of the times it isn’t the worst. What you are doing is called catastrophizing. This only makes any problem worse sometimes multiple times worse than the actual problem.

            Find yourself a good chiropractor or physiotherapist, get them to calm you down then treat your problem.

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