Welcome to “The PT Handbook!” This handbook will provide practical physical therapy tips and dive into hot topics surrounding the sports rehab world.
This newsletter is an extension of our philosophy at “Art of PT Sports & Performance Physical Therapy,” a PT private practice, where our patient population includes athletes and active individuals. Struggling with pain or injury? Reply to this email. Let’s set up a call to get you back to 100%.
Dr. Gerry Robles PT, DPT
Founder, Art of PT Sports & Performance Physical Therapy PLLC - Athlete-level care for every active body
PT Handbook Conversation: “I Have Back Pain Do I Need an MRI?”
MRI’s often do more harm than good…
Back pain can be scary. I've had it (really bad for 2 years actually) and I see countless physical therapy patients who had it or currently have it.
When it doesn't go away after a few days, it's natural to wonder:
"Should I get an MRI?"... I've heard this question definitely over 100 times as a physical therapist. And it amazes me how many times the answer is NO.
Most people with back pain don't need an MRI right away. Sounds surprising but it isn't...
That doesn't mean MRIs aren't useful. They absolutely are but only in the right situations. But for the vast majority of back pain, an MRI won't change the initial treatment plan. 90% of back pain is considered non-specific in healthcare, meaning there's no true structural abnormality in someone's body. YES 90%.....
In fact, imaging often finds things like bulging discs, arthritis, or degenerative changes in people who have no back pain at all. ooohhh nooo sooo scary.... 🫠
Those findings can sound alarming on a report. But many of them are simply part of normal aging….just like getting wrinkles or gray hair.
That's why treating the MRI instead of treating the person can sometimes create more fear than answers.
Question to all you who read this…when you’re dealing with back pain, what is the biggest thing holding you back?
Is it the fear that you’re doing permanent damage? Or doing more damage?
Is it not knowing if your exercise routine is "safe"?
Or do you just not have a clear plan to get back to 100%?
Hit reply and let me know. I read every email that comes in, and I’d love to hear what you’re navigating right now. And I’d love to help of course (either in person or virtual coaching) 😇
Regardless, what matters most is how you're feeling, how you're moving, and whether there are signs of something more serious. I always tell patients to "go off of your symptoms not what the MRI says" and the best spine specialists/back surgeons I know (and who I refer to if needed) say the same thing.
But of course, there are times when imaging is important. And it's my job as a physical therapist to tell you when...
For example, if someone has significant trauma, progressive muscle weakness, changes in bowel or bladder function, unexplained weight loss, fever, or other concerning symptoms, medical evaluation and imaging may be necessary. These are all considered "red flags" to which I would then refer you to the aforementioned spine specialists I can call or text.
But for most episodes of back pain?
The best evidence points toward staying active, gradually returning to movement, and building strength over time. Your body is often much more resilient than you think.
People often search for the "perfect scan" to explain their pain.
But long-term recovery usually comes down to consistently doing the basics well. Keep moving. Get stronger. Prioritize sleep. Eat enough protein. Manage stress.
These are the best "pain killers" and science would support these as great "pills" as well.
These habits do far more for your long-term health than any MRI report ever will.
The takeaway- An MRI can be an incredibly valuable tool...but it's not always the first step.
For many people, the best treatment starts with education, movement, and a plan to gradually rebuild confidence and strength.
Sometimes the most reassuring thing isn't seeing a picture of your spine.
It's understanding that your back is stronger and more adaptable than you may have been led to believe.
Got back pain that won’t go away? Reply to this email and tell me your story.😊
My newest podcast with coach Ramy is under all this text! We talk about having a training program structured for longevity and not just “being hardcore”. New one coming next week! Enjoy this one in the meantime😃
👉 Check out Thorne supplements HERE and get 10% off your first order!
Some links in this newsletter are affiliate links. I only recommend products I personally use or trust as a PT. If you purchase through these links, I may earn a small commission at no extra cost to you. I am a Thorne/Legion supplements ambassador and trust their products.
Having pain or have a nagging injury? Reply to this email and tell me your story! I read everything. Or just book below:
Enjoying The PT Handbook? We’d love to hear what you think! Hit reply and let us know 😄 Did this newsletter help?
Peace,
Dr. Gerry Robles PT, DPT
Founder, Art of PT Sports & Performance Physical Therapy PLLC - Athlete-level care for every active body