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  • Dr. Jennifer Kean, PT

We treat you, not your picture!

It can be very frustrating to experience pain that just won't go away. The back ache that lingers, or the sharp shoulder pain that doesn't seem to be getting any better. Most patients I evaluate would suggest they need an MRI immediately to figure out what is going on - but is that always the most valuable option?

As you may know, an Xray offers information regarding the bone structure and integrity of a body region. It can be useful to rule out a fracture after a traumatic incident, or a bony abnormality. An MRI (Magnetic Resonance Image) differs from an Xray in an orthopedic setting as it offers information of the integrity of soft tissue in the targeted body region. This can include vertebral discs of the spine, or ligament integrity in the knee or ankle. It can confirm a rotator cuff tear or can confirm the absence of a labral tear. Imaging can offer useful information after an injury, however it doesn't always give you the whole picture.

An MRI is valuable because it can confirm the presence of an injury which needs urgent surgical/invasive attention. The limitation of this type of imaging includes picking up on normal wear and tear injuries, even if these injuries aren't the cause of your pain. Conversely, your MRI results could appear mostly normal, but you may still have some unexplained pain and limitations. Most orthopedic surgeons don't rely entirely on an MRI result when evaluating a patient and determining whether or not an invasive procedure is necessary. In fact, most orthopedic surgeons will refer to a physical therapist for further assessment and treatment to confirm their suspicions about a diagnosis. Ultimately, taking into consideration the patient's clinical presentation and regular assessment in a physical therapy setting is often a more valuable tool.

A physical therapist is trained to complete a comprehensive evaluation of each patient based on their symptoms, not only include range of motion and strength, but also what is known as a "special test". These special tests allow us to clinically discern with better reliability and validity what may be going on within a joint or body region. A physical therapist can diagnose within reasonable doubt the integrity of ligaments in all joints in the body, muscle strains or tears or the possibility of a pinched nerve, based on your pattern of symptoms. Even with results of an MRI, the therapist will always treat you and your symptom presentation, and not just what they suspect based on the picture.

A physical therapist is trained to continuously assess your response to different exercises and movements, and oftentimes your pain can be managed without the need for further invasive treatments. A physical therapist will also educate you on exercises to continue after your discharge to manage your condition independently with longer lasting results. There is a time and a place for having an MRI completed after an injury, however it's important to note that an MRI alone without comparison with a physical therapist's regular assessment won't always paint the most comprehensive picture.

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