Should I Get an MRI?

I get this question all the time.

This could easily be an entire series of articles, but let’s see if we can simplify it.

The honest answer is: it depends.

One of the first things I want to know is how the injury happened.

Certain mechanisms of injury are strongly associated with specific diagnoses. For example, a knee that collapses inward during a landing is commonly associated with an ACL tear. Falling with your arm outstretched and the trunk rotated can be associated with a shoulder dislocation.

In situations like these, where the mechanism raises concern for a significant structural injury, I am much more likely to recommend imaging to rule out something serious.

Physical therapists are also trained to perform many of the same orthopedic special tests used by physicians. After evaluating strength, range of motion, ligament stability, and symptom response, we can often determine whether imaging is necessary or whether conservative treatment is appropriate.

But what if there was no clear injury?

This is where the MRI question becomes more complicated.

I often hear this from people with chronic back pain or long standing shoulder pain. They want to know whether getting an MRI would change the rehabilitation plan.

When someone comes to me after months or years of symptoms, I usually ask a question in return:

“If this problem stayed exactly the same as it is right now, would you be willing to get surgery?”

If the answer is yes, that is typically when I recommend consulting with an orthopedist to discuss imaging and potential next steps.

Most people, however, want to avoid surgery if possible. For those individuals, physical therapy is usually the best place to start. The goal becomes improving function, reducing pain, and restoring performance without ever stepping into an operating room.

So when should you consider an MRI?

If there is a concerning mechanism of injury, imaging may be appropriate.

If a physical therapist or orthopedist identifies red flag findings during an exam, imaging may be necessary.

If you have persistent pain and are seriously considering surgery, imaging becomes more relevant.

Otherwise, many conditions respond very well to a structured rehabilitation program.

It is also important to understand that imaging findings do not always equal pain. Many people have disc bulges, labral tears, or tendon changes on MRI and have no symptoms at all. That is why clinical evaluation and symptom presentation matter just as much as what shows up on a scan.

If you do end up getting an MRI and speaking with an orthopedist, make sure to also involve your physical therapist in the conversation so you can establish a clear plan moving forward.

There is strong evidence that completing physical therapy before and after surgery significantly improves outcomes. Even when surgery is necessary, preparation and proper recovery matter.

If you are unsure whether imaging is the right next step for you, reach out. We are happy to help you think through the decision and guide you in the right direction.