Do X-Rays and MRIs really help doctors make accurate diagnosis of spine and joint pain? That surprising answer is NO!
There has been a lot of research done on the guidelines for treating spine and joint pain and this research has concluded that for the most part, diagnostic imaging (x-rays, MRIs, etc.) should NOT be used as a screening tool for pain. The reasons is there are too many false positives. What this means is that if we took 100 people off the street, took a MRI of there low back, 50 of them would have some sort of positive finding (degenerative changes, bulging disc, herniated disc, etc.). But, those 50 people would not be the same people who reported having pain!
What the above study tells us is there are functional reasons for spine and joint pain, and that it isn’t that important what a joint looks like on diagnostic imaging. The function of a joint is to move, and to move based on how it is designed. Some joints aren’t supposed to move very much in certain directions, like the lumbar spine and rotation. Some joints are designed to move a lot in all directions, like the shoulder joint. A joint can look bad on an x-ray or MRI and still function okay and therefore not be painful.
And no, even if you have a joint that looks bad on imaging it doesn’t mean you are going to have lots of pain in that joint. I have seen some pretty bad looking joints in the spine and extremities, but have been able to change their pain quickly and have it last. What I do is change the function of the joint, I don’t need to change the structure of it. The model of healthcare has to change when it pertains to spine and joint pain. We have to get away from the structural model and lots of diagnosing based on imaging and start to use a functional model where we diagnose based on how a joint moves and treat based on those findings.