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


102 Responses to MRI, CT Scan, X-rays: Is An MRI, CT scan or X-ray best for my pain?
  • Ken Duran says:
    November 29, 2019 at 5:36 pm

    i was in Hawaii and I fell twice when taking a nature hike in the forest. I fell on my right side on some rocks. I had an x ray done but it did not show anything broken. but i get throbbing pain at times in my sidearm muscle and lifting my arm at times hurts. I can also feel and hear snapping or crunching or grinding sounds at time when I lift my are and twist it. . It feels great when I have hot water on it in the shower but after that not so well. I cant sleep on my right side because of my it and it get pretty uncomfortable at nite. I cant even do my push ups. I feel that I need a MRI because I feel that I have a tear somewhere in a ligament that the x ray did not find. What do you think.? Thank you

    • Dr Ken Nakamura says:
      January 28, 2020 at 9:48 pm

      Thanks for your question Ken. You can definitely injure soft tissue when you fall on rocks. You can cause a contusion or bruise your bone which can take up to 6 weeks to heal. Other tissues like muscles, tendons and ligaments can become stretch or even tear. It’s best to get the opinion of your chiropractor, physiotherapist or medical doctor first before deciding if advanced imaging is needed. Often a plan of management is determined and a course of treatment is laid out by your chiropractor or physiotherapist. Medical doctors can give you medication or refer you. Their job is not to treat but to diagnose you with or without the help of imaging.

      While it is not common it is possible there may still be inflammation there still as you feel better temporarily but worse after your shower. If there is inflammation adding ice to the area for 10 minutes at time would be helpful. Make sure you apply a cloth next to the skin then the ice pack to protect the skin. You should never put ice directly on the skin. The above assumes there is no open would. If there is then you would need proper wound care from a medical doctor, nurse or nurse practitioner.

      In summary, you should ask a health care practitioner in person if you need an MRI. Most of the time they are not necessary.

      The above is an opinion and not a recommendation. Hope that helps your 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. https://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.

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