Education to Avoid Harm

Kudos to the team at JOSPT and the just released November Special issue on the topics surrounding the use of MRI in musculoskeletal care. Led by Guest Editor Dr. Jim Elliott this issue is a must read for physical therapists practicing in musculoskeletal care.   It is well known that appropriate use of imaging can be invaluable in low back pain management particularly for determining serious pathology.  Unfortunately, the alarming over utilization of this technology can have serious consequences to the patient including increasing referrals, drugs, surgical rates and decreased perception of health.  An image is extremely powerful.  I have noticed that when I look in the mirror I have more wrinkles on my forehead, is this serious? Is this normal?  It sure looks serious!   We frequently see patients that have been harmed by the scary stories of what their MRI looks like. When examining these patients it is helpful to have examples to counteract this. The above paper provides some examples to use in the clinic.

The overutilization of imaging extends well beyond low back pain.  I encourage the blog readers to also check out the recent article in the NY Times where the renowned surgeon Dr. James Andrews described the MRI of 31 professional baseball pitchers who were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” says Andrews.

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