When Might You Need an MRI? A Guide for Chiropractic Patients

Upright MRI Scanner at HUS Clinic Bournemouth

By Leslie Budzynski DC ~ BCA Registered Chiropractor (BCA Reg. No. 0072) since 1987 & GCC Registered Chiropractor (GCC Reg. No. 00043) since 1999 | Bournemouth Chiropractic

If you have been coming to see me or are a new patient before we embark on a course of treatment, I may have suggested an MRI scan. You most likely will have questions and be wondering what that involves, why I have recommended it and where to go locally. This post answers those questions and covers everything about that refeal that we would discuss in person.

Most people with back pain, neck pain or shoulder pain do not normally need an MRI scan. The majority of musculoskeletal complaints respond well to chiropractic assessment and treatment without requiring any additional imaging at all.

Sometimes though, there are situations where having a clearer picture of what is happening inside your body is important and can genuinely change the approach to a course of treatment. In those cases, I refer patients to the open upright MRI service at the Health Sciences University (HSU) Clinic which is right here in Bournemouth.

What is an MRI scan?

MRI stands for magnetic resonance imaging. MRI uses powerful magnetic fields and radio waves to produce detailed images of the soft tissues inside your body including the intervertebral discs, nerves, ligaments and muscles. Unlike X-ray, it does not use ionising radiation. During the scan you will hear a rhythmic knocking sound as the magnetic coils switch on and off, but the process itself is completely painless and non invasive.

MRI is particularly good at identifying disc herniations, nerve compression, spinal stenosis and soft tissue conditions that are not visible on X-ray. It provides a very thorough piece of medical information and is a valuable tool in the healthcare arsenal.

When might I recommend an MRI?

Here are a few examples of situations when I would consider referring a patient for an MRI:

Symptoms are not responding to treatment as expected and more detailed information is a benefit
There is significant nerve involvement, numbness, weakness or radiating pain into an arm or leg
I need to rule out more serious underlying causes before proceeding with treatment
Symptoms suggest disc pathology that would benefit from a clearer structural picture, MRI provides this
A patient is considering other interventions such as injections or surgery to address the pain and imaging is needed to inform that decision

For a broader look at what MRI findings typically mean for back pain and how we use them, then this blog post is a useful read low back pain guide

Red Flags and When Urgent Investigation Cannot Wait

In a small number of cases, symptoms can indicate something more serious than a mechanical spinal problem. These are known as “red flags” and require prompt medical attention and in some cases, an urgent MRI referral, rather than a course of conservative treatment.

I screen every new patient for red flags at their first appointment. If there is any indication that they are present, I will refer you to your GP or where appropriate, advise you to seek emergency care:

Possible cauda equina syndrome, this is a medical emergency. Seek immediate medical attention if you experience:

Loss of or altered sensation in the saddle area (inner thighs, perineum, genitals)
Bladder dysfunction including inability to urinate, loss of control or altered sensation when passing urine
Bowel incontinence or loss of control
Progressive weakness in both legs

The presence of a red flag does not automatically mean something serious is wrong but it does mean the symptom needs to be properly investigated before proceeding with any chiropractic treatment. An MRI is often the most informative way to rule out serious pathology.

The open upright MRI at HSU Clinic Bournemouth

We are fortunate to have an imaging facility right on our doorstep. The Health Sciences University (HSU) Clinic . Health Sciences University was until recently known as the AECC Clinic. It operates one of the few open upright MRI scanners in the UK and is the only one on the South Coast of England, at teh time of writing. I trained here back in 1987, it is a world renowned centre for chiropractic training and its facilities are second to none.

This scanner is significantly different from the conventional tube shaped, tunnel-style MRI that most people are familiar with. The best thing about this scanner is that patients are not required to lie in an enclosed space. Instead, they can be scanned sitting, standing or in other positions. This makes it particularly well suited to and makes a huge difference for:

Patients who experience claustrophobia with conventional scanners
Patients who cannot lie flat due to their pain or injury
Larger framed patients who find conventional tunnels uncomfortable
Situations where we need to see how the spine behaves under load which is something a traditional lying-down scan cannot show

The service is paid for by yourself, the patient and is run by fully qualified radiographers. The MrI reports are returned directly to me as the referring clinician so I can discuss the findings with you at your next appointment.

How the referral works

If I decide that an MRI would be useful, I discuss it with you and then I complete a referral form and send it directly to the HSU Clinic team. They will then contact you directly to arrange your appointment. You do not need to go through your GP for a referral, which typically means a much shorter wait than the NHS pathway. I can happily refer you back to your GP if this is something yu prefer.

Once the results arrive, I discuss them with you in full, explaining to you what the scan shows and how the findings will affect the plan going forward.

The Upright MRI Scanner at HUS Clinic Bournemouth is based in Boscombe, around five to six miles from our clinic at 42 Branksome Hill Road.

For current booking enquiries and pricing, contact the HSU Clinic directly via their website: clinics.hsu.ac.uk/services/clinical-imaging/mri.

If you need to see a Chiropractor

If an MRI does confirm that chiropractic care is the right path forward for you then here is what to expect at your first appointment. I offer a free 15-minute chiropractic consultation. We can talk through what you are experiencing and whether chiropractic can help you and where to go from here.

: Your first visit to see a chiropractor at Bournemouth Chiropractic

Medical Disclaimer

This post is intended for general informational purposes only and does not constitute medical advice. Individual circumstances vary and the information provided here may not apply to your specific situation. If you have experienced a recent fall, suspect a fracture, have lost consciousness or are experiencing sudden weakness, numbness or difficulty walking, please seek urgent medical attention. If you have a diagnosed condition such as osteoporosis, a neurological condition, or are taking blood-thinning medication, please inform your practitioner before beginning any new treatment or exercise programme. Leslie Budzynski is a registered member of the British Chiropractic Association (BCA) and the General Chiropractic Council (GCC). You can verify Leslie’s registration at any time on the GCC’s online register.

References

The clinical criteria and imaging guidance referenced in this article draw on the following published sources:

NICE Clinical Guideline NG59 — Low back pain and sciatica in over 16s: assessment and management (2016, updated 2020). National Institute for Health and Care Excellence. Recommends against routine imaging for non-specific low back pain, while supporting urgent investigation when red flags are present. nice.org.uk/guidance/ng59
Finucane LM et al. (2020). International Framework for Red Flags for Potential Serious Spinal Pathologies. Journal of Orthopaedic & Sports Physical Therapy, 50(7), 350–372. A consensus framework establishing the evidence base for red flag screening in spinal patients. doi:10.2519/jospt.2020.9971
Verhagen AP et al. (2016). Red flags presented in current low back pain guidelines: a review. European Spine Journal, 25(9), 2788–2802. Reviews the consistency and evidence behind red flag criteria across international guidelines. doi:10.1007/s00586-016-4684-0
Lavy C & James A (2009). Cauda equina syndrome. BMJ, 338:b936. A widely cited clinical overview of cauda equina syndrome, its presentation, and the importance of emergency MRI. doi:10.1136/bmj.b936
Patel ND et al. (2020). ACR Appropriateness Criteria: Low Back Pain. Journal of the American College of Radiology, 13(9), 1069–1078. Evidence-based guidance from American College of Radiology on appropriate use of MRI in low back pain. doi:10.1016/j.jacr.2020.09.025