We have noticed an aggressive trend of increase MRI studies on low back patients over the past year. It is important to note that the false positive rates for lumbar MRI’s are quite high. Several studies or investigations have been conducted looking at groups of people who have never experienced back pain and had MRI’s taken. These asymptomatic individuals presented with disk bulges, protrusions, and extrusions. We see this often in the clinic as many patients come in with MRIs that show pathology on the opposite of involvement and we are quick to point out the importance of these false positive rates.
The McKenzie method or mechanical diagnosis and therapy (MDT) utilizes a phenomenon known as “centralization” which has been shown to be a more accurate indicator as to successful outcome for discogenic problems. Studies by Donelson have reported that referred symptoms to the buttock, thigh or leg in 89% of patients with acute pain, centralized during mechanical assessment. Of this centralization group, 91% have excellent outcomes resulting in complete relief of pain and restoration to function.
Some insurance plans are now requiring an MDT assessment be done prior to MRI studies to avoid the problematic issue of false positives and excessive cost. Of those patients that do centralize, we not only reduce their pain and restore function, but they also learn a valuable tool on how to prevent recurrent episodes.
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