"All men by nature desire to know." – Aristotle

Magnetic Resonance Imaging (MRI) is one of the most commonly requested diagnostic tools for musculoskeletal injuries. The technology provides highly detailed images of soft tissues, joints, and bones, making it a valuable resource for identifying serious conditions such as fractures, tumors, and ligament tears. However, despite its ability to capture clear images of internal structures, an MRI is not always the best first step in injury recovery. In fact, using MRI too soon can lead to unnecessary costs, prolonged rehabilitation, and even unnecessary medical procedures. That does not sound fun.

Over-reliance on MRIs can also create unnecessary stress for patients, leading them to believe that normal age-related changes are problematic. This can push individuals toward interventions that may not be necessary, making the recovery process longer and more expensive than needed. Knowing when an MRI is truly beneficial can help streamline the healing process and improve outcomes.

What Is an MRI and What Is It Used For?

An MRI is a medical imaging technique that uses powerful magnets and radio waves to generate detailed images of the body's internal structures. Unlike X-rays and CT scans, which primarily focus on bones, MRIs excel at showing soft tissues such as muscles, tendons, ligaments, cartilage, and nerves. This makes MRIs valuable for diagnosing conditions like:

• Torn ligaments (e.g., ACL tears)

• Herniated discs and spinal conditions

• Muscle strains and tears

• Cartilage damage (e.g., meniscus tears)

• Tumors or infections

In addition to diagnosing injuries, MRIs are sometimes used for monitoring disease progression, such as tracking the development of arthritis or degenerative conditions. However, routine use of MRIs in the absence of significant symptoms can often lead to misleading results.

Why Early MRIs Can Lead to Unnecessary Costs

While MRIs can provide valuable insights, they are often overused in cases of musculoskeletal pain, leading to increased healthcare costs and unnecessary treatments. Many doctors and physical therapists advocate for a more conservative approach—such as clinical assessment and functional movement testing—before jumping to an MRI. Here’s why:

1. Incidental Findings Lead to Unnecessary Procedures
   MRIs are so detailed that they often reveal age-related changes that may not even be causing pain. Studies have shown that:

   • 37% of asymptomatic people in their 20s have signs of disc degeneration in their spine. The number of people with these "symptoms" increase as we age.

   • 57% of people over 60 have rotator cuff tears, yet many experience no pain.

   • 90% of people over 50 show signs of degenerative disc disease, even if they have no back pain.

   • 43% of older individuals have cartilage lesions, meniscal tears, and bone marrow lesions in their knees

   • 60% of people with no wrist pain have some TFCC abnormalities

   • 85% of elite soccer players have degenerative changes at their foot and ankle complex

   Seeing these findings on an MRI can lead doctors to recommend invasive treatments, surgeries, or extended rest, even when those issues were never the true cause of the pain.

   Additionally, these incidental findings can lead to unnecessary referrals to specialists, additional imaging tests, and even exploratory surgeries—all of which increase costs and lengthen recovery time.

2. MRIs Increase Costs Without Changing Treatment Plans
   A 2018 study found that early MRI use in low back pain patients increased total medical costs by $4,793 per patient without improving long-term outcomes. Many conditions identified on MRIs don’t require surgery and can be managed effectively with proper rehabilitation and strength training.

   Moreover, insurance companies often pass these costs on to patients, making medical care more expensive for everyone. In cases where physical therapy or other non-invasive treatments would be just as effective, an MRI can be an unnecessary financial burden. Which is for most conditions, even after surgery!

3. Psychological Impact: Fear and Avoidance
   Seeing an MRI report with words like “degeneration,” “tear,” or “bulging disc” can cause unnecessary fear, even if those findings are normal for aging and not the source of pain. This can lead to avoidance of movement, increased pain perception, and a slower recovery process. Patients may feel discouraged and believe they are more injured than they actually are, which can negatively impact their motivation to engage in rehabilitation exercises.

   Fear-based avoidance of movement can result in deconditioning, which can actually make pain and stiffness worse over time. It’s crucial to understand that just because an MRI shows an abnormality does not mean that it is the cause of pain or requires surgical intervention.

When Is an MRI Actually Necessary?

MRIs are valuable when used appropriately. Situations where an MRI is warranted include:

✅ If there are red flag symptoms, such as unexplained weight loss, night pain, fever, or neurological deficits (e.g., loss of sensation, weakness, or bowel/bladder dysfunction). These would be urgent referrals.
✅ If a surgical intervention is strongly indicated, such as a complete ligament rupture or a fracture that requires stabilization.
✅ If an athlete needs precise imaging to determine the extent of a sports-related injury before making return-to-play decisions.

The Bottom Line: Movement First, MRI Later

MRIs are powerful diagnostic tools, but they are often overprescribed, leading to increased healthcare costs, unnecessary procedures, and longer recovery times. Before requesting an MRI, consider whether it will actually change your treatment plan. In many cases, an experienced clinician can guide your recovery more effectively without the need for expensive imaging.

If you're dealing with pain, don’t panic over an MRI result that shows “degeneration” or “arthritis”—these changes happen to everyone as they age. Instead, focus on movement, strength, and function—because that’s what truly determines your ability to train, race, and live pain-free.

Understanding when and why to use MRIs can help patients make better decisions about their health. Next time you're considering an MRI, ask yourself: Will this change my treatment plan, or is there a more effective path forward?

If you feel lost, and need guidance, I can help you along that path. Book a call with me here: https://roadtodawnwellness.com/book-page-7052