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X-Rays And Mri’s. When To And When Not To.

One of the most common questions I get asked by clients and potential clients is:


As humans we like things that are tangible and known. We struggle with uncertainty and the unknown. I get it and it makes perfect sense. If we knew what structure was damaged or abnormal we could surgically repair it or have an exact treatment option to address the issue.

However, it is NOT that simple. And it fails to respect the complexities of human pain.

Although this post is not intended to discuss the complexities of pain we will mention that hurt does not equal harm. We can have pain in the absence of actual tissue damage.

MRIs reveal disc degeneration in 20 percent of 20-year-olds, 40 percent of 40-year-olds, and more than 80 percent of patients over 60 who do not have any back pain.Disc herniations and spinal stenosis are also frequently seen in asymptomatic patients on MRI scans. MRIs can over-diagnose back problems and may lead to invasive and often unnecessary treatment. Not to mention pain catastrophization, fear, and anxiety with over-medicalizing (yes I made that word up) a non-medical problem. I do not have any specific data to represent what I am about to say; however I believe that if we compared two groups with similar symptoms, onset, age, etc…

Group 1: Received MRI first and then physical therapy

Group 2: Physical Therapy First with NO MRI

Group 2 would have better outcomes, both short and long term, for the very reasons mentioned above.

So not only are MRI’s a poor indicator of injury and pain generation but they also provide something we may all be currently familiar with.. FALSE POSITIVES.

It would be more abnormal if your medical image was perfectly NORMAL. The abnormal findings are just that, normal. Some degeneration, calcification, arthritis, etc. Yes, those are all normal. And whose to say those abnormal findings weren’t present BEFORE the onset of your pain? Over-diagnosing and mis-diagnosing come with consequences. Framing and contextualizing the normalcy of these findings is KEY for getting out of pain. STEP 1 for Myomuv for helping you get out of pain is a clear understanding of the pain generators!


-Specific MOI that resulted in trauma or possible boney fracture

-Muscle weakness and changes in sensation that last more than several weeks.

-Radiating nerve pain that does not resolve with position changes after a few weeks

-Difficulty walking with noted gait and balance disturbances

-Saddle Paresthesia and changes to your bowel and bladder. 

-3-6 weeks of Conservative treatment has not improved symptoms.

MRI’s are typically used for more than just orthopedic and musculoskeletal aches, pains, and injuries involving nerves, muscles, ligaments, tendons, and the spine , including discs, spinal cord, nerve roots, and ligaments. They are far more useful for imaging of the brain during cases of tumors, strokes, multiple sclerosis.

X-RAYS are used for many orthopedic conditions such as:

  • bone fractures or abnormalities

  • calcification in body tissues

  • arthritis

The most widely overused condition is arthritis. Having an understanding of what arthritis means and the normalcy of this “condition” is key to proper treatment. The loss of joint space is as normal as wrinkles on the skin and hair turning gray. Physical therapy certainly won’t be able to add space to the joint, neither will an image; but it can make you more capable and tolerant to the everyday forces applied to that joint you will encounter.

The average cost of medical imaging is between $1,200 to $4,000 for an MRI and between $100 to $1,000 or more depending on the complexity and location.


I would begin by finding a physical therapist you trust. At Myomuv we aim to avoid the use of medical imaging, unless based off of our expertise and professional opinion, it is absolutely necessary. We have seen athletes and clients in the past for an evaluation and felt they needed advanced medical imaging to progress forward with their recovery. However, those instances are few and far between. Typically we tell our clients that they should be out pain within 3-6 visits over the course of 3-6 weeks. At that point if we have not made any meaningful change in your symptoms and limitations, then we can look towards medical imaging.

Looking beyond a purely patho-anatomical model we will discuss other contributions to your health and wellness like:



nutrition and hydration

social connections

mental health

How you think, how you connect, how you fuel your body, how you rest, and how you move and train are all part of being healthy. Each positively OR negatively impacting one another.

We need to understand that most orthopedic aches and pains that are non-traumatic or lack clear red flags, are not medical problems, so we do not need the medical system to solve them. We need a more conservative approach that is free of the medical system like physical therapy. At Myomuv our physical therapist are trained at a doctorate level to assess your movement machine. The information they give you will be more useful than just a simple diagnosis on a medical image. The information will be used to guide you on your path out of pain and back to the lifestyle and activities you love.

So what does it look like to work with Myomuv

Are you someone that is tired of dealing with the unknown of where your pain is coming from? Have you tried physical therapy in the past and didn’t have as much success as you would have hoped for? Do you feel unseen by the current state of our medical system? Maybe you’re not hurt enough to warrant a doctor’s visit but you know your pain is very real. You want to avoid medications, injections, AND…. MEDICAL IMAGING? We think you would be a great fit for Myomuv! You are the ideal client for us. We love working with others just like you. We love listening to your story. We love connecting over your goals and desires. We love seeing people get out of pain and stay out of pain.

What’s keeping you from where you are now to where you want to be?

Get a really expensive and fancy image OR learn about your movement system. Learn how to stretch. Learn how to move properly. Learn how to obtain strength. Learn how to age gracefully.




Dr. Bryan Keith

Myomuv PT

We help active adults and athletes return to the activities they love without pain, without taking time off, and feeling more confident and capable than ever before.