Why MRIs for Low Back Pain Can Do More Harm Than Good | Sustain Physical Therapy and Performance

Many patients believe that knowing more about their condition through imaging will help their treatment. However, for non-specific low back pain, research shows that imaging, particularly MRIs, can often lead to unnecessary treatments, increased medical costs, and, in some cases, worse outcomes.

Let’s take a closer look at why MRIs aren’t always the best first step for low back pain and how conservative treatment approaches, like physical therapy, are often a better solution.

Low back pain is one of the most common reasons people seek medical care, and in many cases, they are referred for an MRI to “see what’s going on.” But studies show that these scans often detect issues that are unrelated to the pain and don’t change the course of treatment.

In fact, MRIs can sometimes do more harm than good when dealing with low back pain. A 2013 study by Lancaster et al. found that early MRIs frequently detect abnormalities, such as herniated discs or spinal degeneration, that naturally occur as we age and are irrelevant to the patient’s pain. These findings often cause anxiety and lead to unnecessary treatments that focus on fixing the image rather than addressing the actual cause of the pain.

One of the most surprising findings from the Lancaster study was the increase in medical costs associated with early MRI use. Patients who received early MRIs for low back pain racked up an average of $13,000 more in medical costs compared to those who pursued conservative treatments like physical therapy.

Why the higher costs? Early imaging often leads to a domino effect of additional tests, specialist consultations, and sometimes invasive procedures like surgery. Even when the MRI findings aren’t the true cause of the pain, the results can lead to interventions that wouldn’t have been necessary had the patient followed a more conservative treatment path.

At Sustain Physical Therapy and Performance, we often see that most low back pain resolves within weeks to months with active treatments like exercise, mobility work, and physical therapy. These approaches address the root causes of pain without the need for costly imaging or invasive treatments.

MRIs can also create a psychological burden for patients. When people see images showing disc degeneration or other “abnormalities,” it can make them feel fragile or damaged, even though these findings are often unrelated to their pain. This fear can cause patients to avoid movement and push them toward more aggressive treatments, such as surgery, when conservative care would likely have been more effective.

This fear-based response is one of the biggest downsides of early imaging. It can make patients feel broken, leading to a cycle of pain avoidance, over-treatment, and increased medicalization. The reality is that many of the changes seen on MRIs—like disc degeneration—are a normal part of aging and don’t necessarily cause pain or require invasive treatment.

At Sustain Physical Therapy and Performance, we believe in empowering our patients by focusing on movement-based treatments that help them understand their bodies and regain confidence in their ability to heal.

While we generally recommend conservative treatments first, there are cases when imaging is necessary. Red-flag symptoms—such as significant neurological deficits or signs of a more serious underlying condition—warrant further investigation through imaging.

These cases, however, are the exception rather than the rule. For most people dealing with low back pain, early MRIs do not change the treatment plan and can lead to overtreatment, increased costs, and unnecessary medical procedures.

Another important finding comes from a 2021 study by Shraim et al., which demonstrated a troubling association between early MRI use and long-term disability in patients with low back pain. The study showed that patients who received early MRIs were more likely to end up with long-term disability, even when the scans didn’t reveal a clear structural cause of their pain.

This highlights one of the biggest risks of early imaging: the anxiety and over-treatment that often follow. The MRI itself—along with the fear it can create—leads patients into a cycle of chronic pain and unnecessary medical interventions.

The takeaway? While more information can sometimes be helpful in cases of injury, too much information—especially when it leads to unnecessary fear and treatment—can actually make things worse.

For most people, conservative care offers the best path to recovery from low back pain. Physical therapy, exercise, and mobility work are all proven ways to reduce pain, improve function, and help you return to your daily activities.

Instead of focusing on what an MRI might reveal, it’s more important to focus on how you move, how your body responds to treatment, and how to improve strength and mobility over time.

At Sustain Physical Therapy and Performance, we specialize in helping people manage and overcome low back pain through personalized, movement-based treatments. Our goal is to provide clarity, a plan, and the assurance that you can recover without unnecessary interventions.

In most cases, MRIs for low back pain are unnecessary and can even lead to worse outcomes. Early imaging often detects unrelated abnormalities that increase medical costs and contribute to long-term disability. Conservative care, including physical therapy, offers a more effective and less invasive approach to managing low back pain.

If you’re dealing with low back pain and want clarity on the best treatment approach, Sustain Physical Therapy and Performance is here to help. Our team of physical therapists in Boston specializes in guiding patients through recovery with personalized care that emphasizes movement, strength, and long-term health.