"I'm going to insist on getting an MRI." How many of you have said this? Sometimes your doctor doesn't order one or tries to convince you otherwise. Why is that? Hint: It's not because we don't care about you.
Imagine this: You go for a run, you get home, and your knee is sore. The next day, your knee is a little swollen. You're worried. Certainly, swelling isn't normal?!? You head off to an orthopedic surgeon's office.
A significant portion of the people I see in my office have stopped running, cycling, or playing tennis because they fear something is wrong and that if they remain active, they will harm themselves further. Is this you? Because very few people are in the office because the pain is significant enough to stop them from running, etc.
Pain has subjective and emotional components associated with it. It's common for me to have someone in the office who is very upset because they haven't run in two weeks. They initially describe their pain as a 6-7 out of 10. After an examination, review of X-rays, etc, we have a long chat about the probable causes of their pain. Then, we dive into whether or not they are causing harm by continuing to run. Once you realize that you can run without fear of further harm the pain score drops and most will go home and lace up that night.
The use of imaging has exploded. Worse, the rise of treatment recommendations based solely on imaging has risen dramatically too. For our paid subscribers we are going to dive deep into how imaging can be useful in the context of a deep discussion, a good examination, and more. Furthermore, we will discuss why treating imaging findings alone can lead us down a dark path.
You cannot unsee your MRI result
Your history and examination are critical. The history is the story you tell us. It is super important in helping us determine what the potential causes of your pain are. These determine the diagnosis... or at least the most likely diagnoses.
We need to listen to you! If we take the time and allow you to speak, you will often give us the proper diagnosis, as well as the proper context.
Every instance of joint pain or true injury has a personality. The same findings don't behave the same way or require the same treatment in everybody. Imaging is important, but it is not often the sole determinant of what treatments you should be offered.
An MRI report might discuss "tears"... but often they're just normal “age-appropriate” findings. Your joints are as old as you are. However, many people understandably can’t get past the fact that something was listed as being “torn.” What’s the downstream cost of a self-imposed limited quality of life — the loss of something you enjoyed doing— and an associated decrease in your physical fitness?