I’ll never forget one patient from my first year of practice. She came in with an MRI report in hand, halfway to tears. She didn’t have an appointment. She had come right off the streets of Manhattan, fresh from her visit with her orthopedist, and asked to speak to a PT for some clarity on her imaging results.

A patient had canceled, so reception called me to the front. I gave my standard line, that I was a PT and not a radiologist, but that I would take a look at her report. It said she had multiple severe disc herniations and stenosis throughout her lumbar spine.

Treat the Person, Not the Image

As I read, I noticed something. She was shifting from side to side, pacing and moving with a lot of frantic energy, which is how most of us would react to news we thought was terrible. I stopped reading and asked how she felt right now. She started jumping and squatting to show me how well she was moving. She said she had pain at times but was able to keep up her daily routine.

I reassured her that evidence shows many of us past a certain age will have findings on a lumbar MRI, and that research at the time supported treating the person, not the image. I told her about PT, and she came in for an evaluation with a colleague. By their report, she was a straightforward case! I firmly believe imaging is a powerful tool that helps countless patients, but research shows it shouldn’t fully guide our treatment.

Image spot (optional): patient moving freely during an exercise session

What the Research Found

A recent article in Physical Therapy (PTJ) explored how the severity of structural lumbar spinal stenosis relates to response to exercise-based PT. The study compared improvements in pain, disability, strength, medication use and function after PT-led exercise interventions, with patients grouped by the severity of their stenosis.

The authors concluded that patients improved by the same magnitude across all structural severities of spinal stenosis. I immediately remembered my patient, how terrified she was of her MRI and how mobile and functional she was.

How many patients avoid being active because of the harm they believe their imaging findings mean? How many never see a PT who could improve their mobility or quality of life, because they’ve been told their spine is too far gone?

What We Can Do

We can keep educating our patients, and those around us, on the importance of focused, purposeful exercise to improve their function, and help them avoid putting everything into their imaging results.