Imaging & Radiology
Do I Need an MRI When I Have a Disc or Nerve Problem? Chiropractors at Charminster Chiropractic Clinic in Bournemouth Discuss
Do You Really Need an MRI for Back Pain?
A lot of people think getting an MRI for back pain will immediately show what is wrong, but in most cases, an MRI is not necessary. Just like with shoulder pain, low back pain usually does not need an MRI right away. Here is why.
Do You Have a Disc Problem?
You might! Disc problems are actually very common. Back pain can range from a small annoyance to really intense pain that makes it hard to move, which can make you worry that something is seriously wrong with your spine. But that is not always the case! Many people with back pain, especially if they do not have extra symptoms like tingling, numbness, weakness, or shooting pain down a leg, are likely dealing with a nerve root irritation, bulging, or herniated disc. Why do you still not need an MRI right away?
What Are Disc & Nerve Problems?
Think of it like squeezing a jelly donut—if the outside of the donut tears, the jelly can ooze out. Inside our spine we have multiple bones (vertebrae) that form the spine. Between each of these bones we have discs that look like cushions that help absorb shock and allow your back to bend and move. Inside of these cushions, we have a soft, gel-like centre (nucleus pulposus). Similar to the jelly donut, if the spinal disc pushes too hard on the tough outer layers, it can ooze out through this layer. This is called a disc herniation.
If a disc herniates, that gel-like centre can push out and press on nearby nerves or even the spinal cord. This pressure can cause a range of problems, like pain, numbness, and weakness in certain parts of the body. In severe cases, it might make it harder to move normally or even affect how you feel and function overall.
Types of Disc Herniation
Disc herniation is grouped into different types based on how much and where the disc has pushed out or leaked.
Contained vs. Uncontained Herniation
Contained Herniation
The gel-like centre (nucleus pulposus) stays inside the tough outer layer (annulus fibrosus) but pushes out a bit, creating a bulge in the disc.
Uncontained Herniation
The gel centre breaks all the way through the outer layer. This can put more pressure on nearby nerves, leading to more noticeable symptoms.
Protrusion and Extrusion
Disc Protrusion
Part of the nucleus pulposus bulges outward but remains connected to the main body of the disc.
Disc Extrusion
The nucleus pulposus breaks through the annulus fibrosus and forms a “neck,” and can cause severe nerve compression.
Sequestration
This is a severe type of disc herniation that happens when the gel-like centre completely breaks away from the disc and moves into the spinal canal. This can cause even more pressure on the nerves and lead to serious problems.
Location-Based Classification
Central: In this type of herniation, the disc pushes toward the middle of the spinal canal, which can press on several nerves at once, causing problems in different parts of the body.
Lateral: In this type of herniation, the disc pushes to the side, which can press on just one nerve, causing pain or other problems in a specific area, like your arm or leg.
Foraminal: In this type of herniation, the disc pushes out in the small openings on the side of each bone in the spine. This can pinch the nerves as they leave the spine, causing pain or other issues along the nerve’s path.
Severity-Based Classification
Mild: This type of herniation is when the disc bulges a little, but it does not press on any nerves, so there is usually no pain or only mild discomfort.
Moderate to Severe: This type of herniation is when the disc pushes out a lot and puts serious pressure on the nerves or even the spinal cord, which can cause a lot of pain and problems with movement.
Symptoms of Disc Herniation
The symptoms of a disc herniation can be different depending on where the herniation happens in your spine, how bad it is, and which nerves are getting pressed.
Pain
The first and most obvious symptom is usually pain. It might be focused in your back, or it could spread along the nerves affected by the herniation, like down your legs or arms.
Sciatica
Pain that travels down the leg is a common symptom, especially if the herniation is in the lower back (lumbar spine) and is pressing on the sciatic nerve. This is called sciatica.
Cervical Radiculopathy
If the herniation happens in the neck (cervical spine), it can cause pain that spreads to the shoulders, arms, and hands.
Numbness and Tingling
As the pressure on the nerves gets worse, you might start to feel numb, burning, cramping, tingling, or like your skin is being pricked with pins and needles along the area where the nerve is affected.
Muscle Weakness
If the nerves are pressed for a long time, it can lead to muscle weakness, usually in the part of the body where those nerves control the muscles.
Loss of Reflexes
If the herniation is really bad, it can cause your reflexes to be weaker or even stop completely. This could be a sign that the nerves are damaged.
Important Note:
Bladder and Bowel Dysfunction
In rare, severe cases of disc herniation in the lower back, a condition called cauda equina syndrome can happen. This can cause loss of control over your bladder or bowels, numbness in the groin, genital area, and weakness in your legs. If you experience any of these symptoms you need to seek immediate help and call 999, as this is a serious medical emergency!
Why an MRI Is Not Always Necessary
An MRI can show changes in the discs or spine, but these changes are often a normal part of getting older. A study in the American Journal of Neuroradiology looked at scans from over 3,100 people who had no back pain, and many of them still showed disc issues (1).
Disc Degeneration (wear and tear)
A total of 37% of people in their 20s had it. During our lifetime and the more we use our bodies, over time and with age the wear and tear will be higher. From the study, they found that by the age of 80, 96% of these people had wear and tear in their spine.
Disc Protrusions (when part of the disc pushes out)
This condition has less to do with wear and tear and age. Therefore, the amount of people suffering from disc protrusion was 29% of 20-year-olds, and 43% of 80-year-olds.
Disc Bulges (a larger section of the disc pushing out)
This condition is in fact very common. Interestingly, it does not often produce any pain or symptoms and has to be more severe to cause issues. Over our lifespan, the cushions (discs) will naturally deflate and become less springy. Therefore, it is more common to see this issue in elderly. In the study, they found it in 30% of people in their 20s and 84% of those in their 80s.
Annular Tears (small tears in the disc’s outer wall)
As we described earlier in this text, it is rather rare to have annular tears. As a result, the study only reported annular tears in 19% of 20-year-olds and 29% of 80-year-olds.
These kinds of changes are common and do not always cause pain. If everyone with back pain got an MRI the majority of them would probably show some “disc issues”, even if these were not the real cause of their pain. From the scans, they would most likely jump straight to treatments such as surgery. A lot of people would potentially end up with unnecessary treatments for their back that might never even bother them. In fact, most disc changes do not lead to pain. Chiropractic treatment along with rest can often help you feel better without needing an MRI or surgery (1).
What Research Tells Us
Research shows that MRI results need to be looked at carefully along with your symptoms and a physical examination. Sometimes, changes found in an MRI can be a part of old age and do not always mean you need treatment. In fact, studies show that MRI results do not always predict how you will feel in the future or how well you will respond to treatments that do not involve surgery (1).
How We Can Help
The Bournemouth chiropractors at Charminster Chiropractic Clinic have long experience with these issues. When someone has intense back pain, we start by talking about your problems and all the signs and symptoms you have. We will then examine you (as much as you are comfortable with) to check for any nerve-related signs that tell us something is not working normally. Next, we will also ask about other symptoms, like changes in bladder or bowel control, which could point to a serious problem (though this is pretty rare). If, after all of this, we cannot find any red flags that tell us we need more investigation, we will start with easy treatment. Our treatments are useful tools to help you feel better using ultrasound, massage, acupuncture, or stretching—sometimes without any back cracking or adjustments. As discussed above, disc herniation can happen for many different reasons. How we would treat you depends on how bad the herniation is and which nerves are affected. Treatment can vary a lot from resting, moving, other gentle care or even surgery in more serious cases (2, 3).
Instead of rushing to get an MRI right away, we will keep an eye on how things go with your symptoms over time. It might feel like we are not doing everything we can, but it is important to understand that we base our decisions on the evidence that is out there. If, however, we have reasons to refer you for an MRI we will not hold back.
The Bottom Line
MRI scans should only be used when absolutely necessary. Most back pain gets better with chiropractic care and we recommend seeing us before having an MRI scan right away. If you are dealing with back pain, seeing a chiropractor for a full examination, receiving treatment, and being patient could help you heal—often without needing surgery.
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