Why an MRI Is Not the Best Ligament Injury Imaging Test

In this article we want to discuss an article that was published in the American Family Physicians Journal. This article brings up a topic that I’ve been talking about for years. And it’s only gotten worse. This article claims that 90% of today’s injured patients who’ve suffered a back or neck injury are working with doctors who do not have a clear understanding of their injuries. Wait, it gets even worse.

There’s A Familiar Lack of Understanding Present in This Article

These same doctors are unable to find the underlying physical conditions of these injuries at a time when these back and neck injuries have never been easier to diagnose. We’ve gone over this before and I am not going to go into depth in this article abut the role that an MRI and stress radiological studies play in picking up the two key bio imaging markers for these injured patients. These injuries account for:
  • #1 Cause of disability and chronic pain: Lumbar Spine Injury
  • #4 Cause of disability and chronic pain: Neck Injuries
  • #6 Cause of disability and chronic pain: Headaches associated with an injury to the ligament of the cranio-cervical junction or the cervical spine itself
I want to go over this with you in detail. I’ll put a link to the article here which appears on the American Family Physician website. The article we’re going to break down is the one called “Non-Specific Low Back Pain in Returning to Work” You can open it up and follow along with me.

I’m going to point out some things that are very prevalent in the market today and this is exactly what needs to change.

It says that as many as 90% of persons with occupational non-specific low back pain are able to return to work in a relatively short period of time. Now, I’m going to contest this point and quite a few other things in this article. You see, this position paper is a telltale sign of today’s market and it’s pushing the agenda that if there are no red flags with a patient, we as doctors can get them back to work quickly.

What are these red flags, you ask?

  • Infections
  • Fractures
  • Cauda Equina Syndrome
If one of these isn’t present a patient should be encouraged to remain as active as possible. We should minimize bed rest. It states that we should advocate the use of hot and cold compresses to minimize swelling and tell patients to take anti-inflammatory medications as desired.

What this article is telling doctors to do…

These patients need to take part in home exercises and be returned to work as soon as possible. Medical and surgical interventions should be minimized when abnormalities are not found in physical examinations. Patients who are having difficulty returning to work after four to six weeks should be examined and studied for possible personal and occupational psychosocial factors. A multidisciplinary program should be strongly considered to prevent a delayed recovery in those patients struggling to return to normal baseline activities and pain levels. One of the biggest problems I see with delayed recovery is that it is often the result of a delay of an accurate diagnosis of what the problem is in the first place. This article rightly points out that these medical doctors openly admit that they do not know what the underlying pathology is as you’ll see here. So, it goes on to say that patient advocacy should include unnecessary and ineffective medical and surgical interventions, work loss, joblessness, and chronic disabilities. The next thing the article states is that the management of low back pain and determining a patient’s safe return to work are common issues encountered by family physicians today.

Challenges include unfamiliarity with:

  • A patient’s individual job demands and requirements
  • Complex Workers’ Compensation systems
  • The vast array of diagnostic and therapeutic interventions of questionable effectiveness and value
The medical doctors in this article are actually openly admitting that most of the diagnostic and therapeutic interventions they order have questionable effectiveness and value when it comes to treating and diagnosing these injured patients.

Clearly, the object of this article is to encourage a plan of conservative care.

What is conservative care?
  • Physical Therapy
  • Chiropractic
  • Massage
  • Acupuncture
This is what most family doctors follow when they talk about following a conservative care path for their injured patients with occupational low back pain. This article throws around a lot of terms, so let’s take a moment and define one of them. Occupational nonspecific low back pain is pain that occurs predominantly in the lower back without neurological involvement or serious pathology. Let’s be real here, okay?

What they are basically promoting in this article is an early return to work for injured patients. And that right there is a huge part of the problem.

It says that according to the United States Bureau of Labor Statistics that there were 4.2 million non-fatal occupational injuries or illnesses reported by private industry. Sprains and strains accounted for approximately 42% of the injuries. So, as doctors they need to understand that when we look at the number of injuries, those involving the back is number one. It’s the number one cause of chronic pain and disability in the world today. And if you remember as I stated earlier the next is number four. That’s a huge number of our injured workers. So, sprains and to the back and neck are going to require doctors in the market who understand what a bio imaging marker looks like in an injured patient with neck or back complaints. Meaning, you will no longer have patients walking around with an incorrect diagnosis of nonspecific mechanical low back pain.

The Role of Risk Factors in Diagnosing These Injuries

This article goes on to attribute the cause of this nonspecific low back pain to certain risk factors. That’s because these doctors will openly tell you that they have no way of accurately diagnosing these patients. In general, medical doctors cannot clearly identify the cause of this pain in 90% of the patients they see. Now, when I say medical doctor, I’m talking about general practitioners. Now, it goes on to say that some physical demands including manual lifting, bending, twisting, and whole-body vibration are associated with an increased likelihood of low back pain. Please note: Association is not equivalent to causation. It should also be noted that personal and occupational psychosocial variables play a more important role in spinal pathology than just the physical demands of the job.

And that’s where it can get kind of tricky…

They openly admit they don’t know the cause of this low back pain, yet in a sentence or two later they are saying there’s strong evidence that personal or occupational psychosocial variables play a more important role in these injuries than the spinal pathology itself. Now, that my fellow doctors… Could not be further from the truth.

Let’s look at what they list as psychosocial risk factors:

  • Depression: Well I would argue that anybody who suffers from chronic pain and cannot get help from the medical community might exhibit signs of depression. Especially in an active person who cannot find relief or understanding from a doctor who understands their condition.
  • Education Level: This is an understanding and belief that those with lower education levels are more prone to chronic disabilities. Again, what does someone’s education level have to do with an injury. Isn’t more likely the case that a doctor who cannot solve a problem with an accurate diagnosis is likely to blame a patient’s lack of education as the basis for the patient himself not understanding their own injury?
  • Excessive Pain: Well, if you are in constant pain and the medical community is not offering relief, over time this can build up. Is there anyone who wouldn’t say that this amount of chronic pain would be classified as excessive?
  • Fear Avoidance: If you are suffering and unable to find anyone to help you, it’s fair to say that you would fear returning to the same position that caused you pain. That’s a totally legitimate concern. That’s not something I would classify as fear avoidance or job dissatisfaction.
  • Somatization disorder: That is when you are putting too much attention on a condition. Si, again if the doctor cannot figure out what the problem is, if they cannot get to the underlying problem that is going to cause you some obvious distress. It would be hard to imagine a condition like this not dominating your life. So, this talk of “putting too much attention” on this condition seems to be unfair from the patient’s point of view.
  • Unemployment Compensation: What does this have to do with a medical condition? If you’re unemployed and trying to get money to live on from an employer whose job caused your injury, I do not see how that causes pain. I would say it’s the same thing with workers’ compensation claims. It’s not fair to say that legitimately injured patients are trying to distort their injuries just to receive some compensation.
All these issues are problematic when you consider what is really going on.

There is no standardized method of diagnosing these injuries.

Even my own profession of chiropractic is problematic. They have not and are unlikely to standardize the workup of these injuries. The major chiropractic schools don’t even teach bio imaging markers that are consistent with soft-tissue injury to the spine. So then, this becomes the problem that all professions have: physical therapy, chiropractic, Medical doctors, medical specialists. They all have the same problem. No knowledge of what is going on with these types of injuries and no way to consistently diagnose them. This is why SmartInjuryDoctors are so important in the market today. I hope that what I just laid out for you is something that you enjoyed because 90% of the patients suffering from back and neck injury should not be working with any doctor who is incapable of diagnosing the underlying condition. Most of these doctors, no matter what their specialty are just making the same mistakes over and over. They end up relying on articles like this one to justify their rush to return patients to the work force. Patients who are still injured and still in pain.

That is what I am trying so hard to change.

With these articles, my podcasts, my videos…I’m trying to reach doctors wherever they are and show them a better way of doing things. That’s what the SmartInjuryDoctors Program is all about. We need the injury market to change because the patients deserve to work with doctors who not only care, but doctors who can get real results. For more information on Spinal Ligament Injuries please check us out at www.smartinjurydoctor.com or check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher. For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com


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