“Do I need an MRI?”

When you hurt yourself and you don’t know what is wrong, imaging may feel like the obvious next step. More information seems like it can only help. But the honest answer is: "it depends".

There are two questions that will dictate whether you need to be getting an MRI now or if there is time to wait. Those two questions are:

1) Do you have any red flag symptoms?

• Red flags are signs that something more serious might be going on. The kind of thing that needs to be ruled out quickly, not managed with a few weeks of rehab. This may include signs of suspected broken bones from a trauma, unexplained weight loss, progressive weakness or numbness, or pain that is not provoked by changes in position among many other things.

2) Will the result of the imaging change your plan of care?

• This is the question people skip, and it's arguably more important than the first. If you got a positive imaging result tomorrow, would it change what you and your provider decide to do? For example, if you got an MRI that showed you had a labrum tear in your shoulder, would you have surgery to fix it? If the answer is no then the image is mostly just a picture. It may confirm what's already suspected (or not) without necessarily changing the path forward.

If the answer to both of these questions is "no", you may be able to push off getting imaging for the time being.

There may even be a downside to imaging: incidental findings (like disc bulges present in asymptomatic people) can create fear-avoidance behavior, anchor people to a diagnosis that isn't the pain generator, and sometimes push people toward more invasive treatment than they need.

Keep in mind that a physical therapist's job during an evaluation is to determine whether you're a good candidate for physical therapy or whether you need to be referred out for further workup. referred out for further workup. Trust that between the therapist's clinical judgement and your rehab goals, the most appropriate decision will be made.