So I was asked if I would be interested in writing a blog about a topic in physical therapy. I have never written a blog before, so needless to say I was nervous and excited at the same time to join this elite group of individuals. When considering topics, I started thinking about what questions I get asked most often as a Physical Therapist in the outpatient setting. Like our teachers used to always say to us (or at least to me), if you are thinking of that question then ten other people are likely thinking the same thing. Well, here is the question at least ten of you are thinking…”How can you possibly know what is wrong with me when I haven’t gotten X-rays or an MRI completed?” I do understand why people ask this question and here is my detailed response about why imaging is more often than not unnecessary.
Physical Therapists are trained to look for patterns in musculoskeletal disorders. When a patient tells me they have knee pain at their joint line which they sustained after a specific event accompanied by popping/clicking, occasional knee locking and pain with pivoting and squatting activities, I am suspecting a possible meniscal tear (tissue that cushions the knee). Our hands on examination and special testing would either further lead us down this road or point us in a new direction. This is a prime example of how we can have a very good educated guess as to what is causing your pain without having an image in front of us. Although a lot of meniscal tears do required further imaging and possible surgery, tears that occur on the outer third, more vascularized area do have the potential to heal on their own. A bout of physical therapy would be the best option in that case.
Images will also show anything that is abnormal in that area of your body, but let’s think about this for a minute… by our twenties many of us already having bulging discs in our spine. An MRI may show this bulging disc and yet you don’t have any pain with forward bending movements or sitting which typically would bring on the symptoms with that diagnosis. Our mind starts to spin in a negative direction knowing there is something “wrong” with us and our likelihood of recovering has now decreased (due to psychosocial effects which is another whole blog in and of itself). Not only will it pick up on unnecessary issues, but it is not always correct either! Here is a personal example. Freshman year of college, I sustained an injury to my left knee while playing volleyball. An MRI was completed shortly after which showed, according to the doctor, that I had partially torn my ACL (anterior cruciate ligament- a very important ligament for knee stability). I went into surgery not knowing if I was going to have a simple arthroscopic procedure or have to undergo full reconstruction. I woke up in a daze and the first question I asked my athletic trainer was if I had the full surgery. She nodded and my head fell back on the pillow in disappointment. What the MRI didn’t detect was that my ACL was completely torn off of the bone and I also had a meniscal tear. Therefore, even when imaging is completed, it may not be correct. So why not see a Physical Therapist FIRST for a thorough examination of your musculoskeletal system and try to avoid wasting time waiting for expensive imaging that may not even be useful. I do understand that physical therapy does not solve every problem. Further imaging may be warranted especially if surgery is going to be the best course of treatment, but even if this is the case, you don’t have anything to lose by participating in a course of PT. Your body will be stronger, more balanced and will recover from a surgical procedure with much greater ease. Who doesn’t want that?! I hope you have enjoyed getting a little insight into my thoughts on medical imaging and come visit us at Chandler Physical Therapy if you have any further questions!
Jennifer C. Berwanger, PT, DPT