Everyone wants an MRI. It’s cool to take a peek inside your body without the downsides of autopsy. But for knee osteoarthritis symptoms does an MRI help anything?
Regular readers of the Rantings know how I feel about ordering imaging before it’s necessary. It doesn’t matter what region of the body it’s in; sometimes TOO much information is not a good thing.
We have already seen studies suggesting that the rates of knee replacements are increasing, but there has been no change in the amount of knee osteoarthritis seen on imaging. What this strongly suggests is that knee osteoarthritis may not be the problem in a large chunk of the cases of knee pain.
For those providers that treat the soft tissues (and no–I’m not talking about exercises and electric stim here–these techniques do NOT treat the soft tissues), this comes as no surprise at all.
I firmly believe, based on the research and my own clinical experience, that most knee pain does not come from arthritis, but rather from pain being created in the soft tissues (muscles, ligaments, tendons, fascia) surrounding the knee joint as well as the imbalance and altered stress placed upon the joint by these damaged soft tissues.
This particular study adds weight to my thought process. Researchers looked at a group of patients who were older than 50 and had no signs of knee osteoarthritis on X-rays. They then examined this group using MRI images of knee and looked for findings that are consistent with osteoarthritis. These included:
- osteophytes (also known as bone spurs)
- cartilage damage
- bone marrow lesions
- subchondral cysts
- meniscal lesions (usually described as a torn meniscus)
- synovitis
- attrition (a wearing down of the joint surface)
- ligament lesions
What they were basically doing was looking at MRI as a tool to see how well findings on an MRI compared with what the patient was experiencing. Here’s what they found:
- 89% of the group had at least one abnormality noted above (osteophytes were the most commonly found at 74%, followed by cartilage damage in 69% and bone marrow lesions in 52%.
- As expected, the higher the age, the higher the prevalence of abnormalities.
- The likelihood of at least one type of abnormality was high in both painful (97%) and painless (88%) joints.
The last point being the most important. Basically, over the age of 50, a MRI becomes less and less important, and may actually lead the unsuspecting physician to recommend a more invasive procedure (injection or worse–knee replacement).
The bottom line is that just because you have something wrong on your MRI, particularly as you get older, does not really mean anything. If you have knee pain, my biased opinion would be to find a chiropractor that specializes in soft tissue treatment (Graston, Nimmo / Trigger point, NMR, Active Release, Fascial Manipulation, etc…) before you do anything else.
It is always worth trying this approach first. If it does not help, you can still opt for more invasive procedures. But the reverse doesn’t work so well…
If you had a knee replacement, was soft tissue treatment recommended to you before the surgery?