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You Probably Don’t NEED an MRI For A Pinched Nerve in Your Lower Back!

You Probably Don’t NEED an MRI For A Pinched Nerve in Your Lower Back!

Dr. Michael Derry, DPT, PT, OCS Jacksonville, Florida
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When my clients are experiencing "pinched nerves", they are often considering an MRI to find the "cause" of their pain. I can tell you, from my experience, it either ends up being a waste of time, or causing more harm than good. Let me tell you why as we dive deeper into MRIs and pinched nerves.

3 Things to Consider Before Getting an MRI for a Pinched Nerve

3 Reasons you must consider before an MRI for a pinched nerve
Understanding MRIs and Pinched Nerves

Where is the Money?

Does the physician own the MRI machine?

The reason this is huge is because the more MRIs that are done on patients, the more money the doctor makes. There is a strong correlation between ordering MRIs and if the practice owns the machines.

We want to always think that our providers have our best interest at heart, but sometimes they are biased. Just something to keep in mind but I dd see it a lot when I speak with my clients.

More Likely to Have Surgery

The second thing that you need to consider is the fact that if you get the MRI, you are more likely to to receive invasive care than conservative care. When I say invasive care, I mean you will be more likely to be prescribed medications, possibly receive injections, and even surgery could be an option.

A study found that there is a 34% chance increase chance of surgery after receiving an MRI
34% increase chance of surgery after an MRI
34% Increase Chance of Having Surgery of an MRI

While they are not avoidable all the time, the best evidence we have says, we need to start with good conservative care for 6 weeks first.

The Lack of Education on the Findings

The final thing that you should consider is the fact that MRI scans do not come with proper education. It is unlikely that after your scan your physician will sit down with you and explain the results before you have a chance to search Google. Unless, you work with a provider like a direct primary care practice.

If you go to your patient portal and look at the impression, it is unlikely it will be in language we can understand and an explanation would be necessary.

As a physical therapist, I always ensure that if my clients have an MRI or a CT or any other scans that can benefit in their care, I take the time to sit down with them and go over the results so we can figure out how to carry on with their treatment that makes sense for their life and body.

How Serious is a Pinched Nerve in Lower Back?

Pinched nerves, while painful, aren't as serious as we used to think. A pinched nerve is inflammation around the nerves that can be caused by many different things. More recently we notice that it's the inflammation that causes the trouble, not actually pinching on the nerve. This applies to stenosis and sciatica! 

For example, if you have pain that is better one day and then worse a day later, well change in the spine doesn't happen that fast and the nerve didn't go from being pinched to "unpinched". Things don't work like that! 

I have seen nerve pain be caused by disc herniations, bulging discs, or just a narrowing around the nerve. Ultimately, the cause of the pinched nerve usually does not change the treatment of it.

How Do They Fix a Pinched Nerve in Your Lower Back?

Fixing a pinched nerve can be tricky. Fixing anything in the body can be challenging. Remember, nearly everyone has back pain n their life and nerve pain is common in many conditions. If we had a fix, no one would have issues but back pain is still the most common and costly condition out there.

That said, relief can be found in many ways. I often use nerve glides and progressive strengthening. Essentially, calm down the nerve then build strength in and around the area. This with lots of learning of your body and education have been found to be helpful in the beginning and in the long run.

Learn Sciatic Nerve Glides
Learn Sciatic Nerve Glides

We monitor for things such as numbness and tingling, burning down your leg, or even changes in your reflexes as we treat to make sure you don't need things such as injections, surgery, and risky medications. This is what the best research says to do.

If you are assessed by a movement professional, and you are not experiencing any of these nerve related symptoms, there is no need for the MRI. Just team up with an experienced movement professional and they will be able to help you move better!


MRI results may not tell you the whole story. The results are hard to understand and once you get your results, you may see that the results do not even apply to your pain! The best thing that you can do is to try conservative treatment first. If you have a pinched nerve, when you move, you probably feel a burst of pain. This is why teaming up with a movement specialist, like a physical therapist, can help you feel better without having to worry about invasive treatments.


1. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. BMJ. 2019 Nov 19;367:l6273. doi: 10.1136/bmj.l6273. PMID: 31744805.

2. Shreibati JB, Baker LC. The relationship between low back magnetic resonance imaging, surgery, and spending: impact of physician self-referral status. Health Serv Res. 2011 Oct;46(5):1362-81. doi: 10.1111/j.1475-6773.2011.01265.x. Epub 2011 Apr 21. PMID: 21517834; PMCID: PMC3207182.

3. Yi PH, Golden SK, Harringa JB, Kliewer MA. Readability of Lumbar Spine MRI Reports: Will Patients Understand? AJR Am J Roentgenol. 2019 Mar;212(3):602-606. doi: 10.2214/AJR.18.20197. Epub 2019 Jan 8. PMID: 30620671.

Dr. Michael Derry is a Doctor of Physical Therapy and board certified in orthopedics. He is very passionate about treating lower back pain and helping people build their resiliency. He has spent time assisting at universities as well as managing large clinics before starting his own practice in Jacksonville, FL.

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