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MRIs - The Positives and the False Positives

Tests – what are they good for?

In the realm of back pain tests, of MRIs that question must be asked. What are MRIs good for when the percentage of useful, influential MRI studies is so minor? False positive MRI results distress those who get such results. They arouse fear or caution where it is not always needed. MRIs like this blur the proper treatment plan. They spend a lot of money. Johnson Chiropractic carefully weighs the need for MRI in the Richmond chiropractic treatment plan of Richmond back pain relief.


Interpretations of MRI images by radiologists often differ.  The true-positive finding rate was 56.4%, and the miss-rate was 43.6%. (1) MRI imaging may produce false suspicion. When following the guidelines of the American College of Radiology, 93% of lumbar spine MRIs were proper. Of those, only 13% uncovered anything suspicious. Of the 36 MRIs that provoked suspicion of cancer or infection, 81% were false-positive. 59% of the follow-up MRIs on those suspicious findings were false positives. (2) MRI imaging may mislead. For example, MRI shows that the appearance of disc degeneration in asymptomatic persons – persons with no back pain – rises with age:  37% in 20 year olds and 96% in 80 year olds; disc bulges: 30% to 84%; disc protrusion: 29% to 43%; annular fissures 19% to 29%. These imaging findings suggest that these are signs of normal aging. They remind all doctors, remind chiropractors like yours at Johnson Chiropractic, to compare all such findings with patient symptoms. (1,3) Your Richmond chiropractor does this!


Choosing Wisely guidelines for American chiropractors recommend not repeating spinal imaging and not getting spinal imaging for patients with acute low back pain in the first 6 weeks of back pain (except when “red flags” are present– issues that suggest something more disturbing). (4) A review of the success of the Canadian Choosing Wisely recommendations for imaging nonspecific spinal pain and symptoms reported that there is very low risk of missing a worrying cause of back pain. (5) The purpose of guidelines is less imaging, fewer false positives.  Johnson Chiropractic wants what’s best for our Richmond chiropractic care patients.


Chiropractors like yours at Johnson Chiropractic review all the symptoms, tests and images our Richmond chiropractic back pain patients [[present on|bring with them39] their first Richmond chiropractic visit. So many back pain patients come to Johnson Chiropractic with MRI images already done. Johnson Chiropractic will look at them but will rely more on clinical exam findings and link them to what the MRI shows. A rule of thumb with the Cox Technic System of Back Pain Relief is to work toward 50% decrease of back pain in the first month of care before ordering additional imaging or testing or arranging surgical consultation. (6)

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Listen to this PODCAST with Dr. Dan Clark on the Back Doctor’s Podcast with Dr. Michael Johnson as he describes imaging for back pain in the program of treatment for pain relief.

Schedule your Richmond chiropractic appointment with Johnson Chiropractic today. Let’s discover together the best path to Richmond back pain relief – with or without MRI imaging!

Johnson Chiropractic carefully chooses when and if MRI images are needed to guide the Richmond chiropractic treatment plan.  
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"This information and website content is not intended to diagnose, guarantee results, or recommend specific treatment or activity. It is designed to educate and inform only. Please consult your physician for a thorough examination leading to a diagnosis and well-planned treatment strategy. See more details on the DISCLAIMER page. Content is reviewed by Dr. James M. Cox I."