While treating patients in the clinic, I am often asked, “how we can properly diagnose and treat without seeing an MRI or X-Ray first?” Although an MRI or X-Ray can be helpful when we are unsure what is going on, physical therapists are trained to perform a thorough clinical examination when you first come in for therapy which helps us determine what is wrong and how we can best treat you. Listed below are the topics that will be discussed:
- What does an MRI or X-Ray tell us?
- What happens during a physical therapy initial evaluation?
- When is the proper time to undergo diagnostic testing?
What Does an MRI or X-Ray Tell Us?
Before we can discuss how important it is to obtain diagnostic testing right away, first let’s discuss what MRIs and X-Rays are. For the purposes of physical therapy, an X-Ray is used to check for broken bones or determine the severity of arthritis or osteoporosis. An MRI is used to assess injuries or abnormalities of the joints, such as the back and knee. These tools give your doctor a good idea of the current state of the tissues in your body and can help rule in, or rule out, what may be going on in your body. Although these diagnostic studies give us a more internal view of what is going on in someone’s body, it does not tell the doctor or physical therapist exactly what to do in order to help that person return to full function.
There are several impairments that may show up on a person’s MRI or X-Ray that are common due to normal aging of the body, so these tools would not necessarily provide an accurate explanation of what is causing the pain. As people age, their body naturally goes through changes and the likelihood that a bulging disc or disc herniation would show up on their low back MRI increases, even if that isn’t what is causing their pain. For instance, studies have shown that 40% of asymptomatic 40-year-old individuals have an abnormality of a disc on low back MRI (1). Since these diagnostic tools show us what is going on internally but don’t necessarily tell us how that is affecting the person’s function, the doctor and physical therapist must perform an examination of the patient to determine best practice plan of care.
What Happens During a Physical Therapy Initial Evaluation?
Physical therapists are trained to perform a thorough clinical examination when you first come in for therapy. They measure your range of motion and strength, analyze your gait and posture, and obtain an assessment of your current functional mobility. Physical therapists will also use the clinical examination to determine if there are any areas of concern that may signal the need for further testing. Not only do physical therapists look for red flags such as signs of cancer or stroke, but they will also look for any signs that the patient may need more invasive procedures, such as injections or surgery.
A well-performed clinical examination by a physical therapist can help determine the correct treatment for you based on how your body responds to various tests and measures. These clinical examinations can also help physical therapists determine when something else may be causing your problem and whether physical therapy is the proper treatment for your condition.
When is the Proper Time to Undergo Diagnostic Testing?
Although you may not necessarily need to get an X-Ray or MRI before starting physical therapy, there are times that those tests are necessary. If your pain or functional limitation came on gradually, or for no apparent reason, then your condition most likely does not warrant these tests right away, and it is safe to participate in physical therapy. However, if you were injured while performing in recreational activities or your normal daily activities, it may be necessary to undergo testing first to ensure that something more serious is occurring, such as fractures or tears.
Diagnostic testing may also be necessary if you have been participating in physical therapy for at least 4 weeks and your symptoms have persisted or worsened. Although you may not be fully recovered within 4 weeks, you should notice improvements in your function or pain, so if you cannot see any improvements then you should discuss options with your physical therapist and doctor to determine whether an X-Ray or MRI may be beneficial to determine if there is something else going on that is preventing your body from responding positively to physical therapy.
References
- Boyles RE et all. Physical Therapist Practice and the Role of Diagnostic Imaging. Journal of Orthopaedic & Sports Physical Therapy. 2011;41(11) 829-834.
- Fritz JM, Wainner RS. Examining Diagnostic Tests: An Evidence-Based Perspective. Physical Therapy. 2001;81(9)1546-1564.
- Sears B. Do You Need an MRI or X-Ray Before Starting Physical Therapy. Very Well Health. 2019.
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