Tuesday, December 27, 2011

That MRI May Harm You!

Magnetic Resonance Imaging (MRI) is thought of as the gold standard diagnostic tool for finding abnormalities of the bones, muscles and ligaments of the body.  But there are many reasons you should be wary of the results of your MRI in the future.

A New York Times article by Gina Kolata in October 2011 commentated on a study where the authors took 31 professional baseball pitchers who were both injury and pain free and gave them a MRI.  The results found abnormal shoulder cartilage in 90% of the athletes and abnormal rotator cuff tendons in 87% of the athletes.  Let me reiterate that these were athletes that did not complain of any previous injury or past or current pain in their shoulder.  Dr. James Andrews, a top sports orthopedic surgeon put it perfectly.  “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an MRI.”

In that same month a Journal, Health Services Research, came out with a study titled “The Relationship between Low Back Magnetic Resonance Imaging, Surgery, and Spending: Impact of Physician Self-Referral Status”  The objective of the study was to examine the relationship between use of MRI and receipt of surgery for patients with low back pain.  Many results came of this study but the most ground breaking was that among patients receiving orthopedic surgery, the likelihood of having spinal surgery increased by 34% if the orthopedic surgeons owned the MRI machine.   The moral of the story may be to ask your doctor if he or she owns the MRI equipment or benefits financially from you getting the MRI before consenting to imaging.  

In November of 2011 an article by Tim Flynn et. al was published in the Journal of Orthopeadic and Sports Physical Therapy (JOSPT).  This article, “Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder that Unnecessary Imaging May Do as Much Harm as Good,” described an MRI as only a picture of a single moment in time.  This picture, let us say of a disc lesion, gives us no compelling evidence that the patient will have prolonged course of impairment or disability.  In simple terms, the MRI has no way of looking at function.

Below are two MRI images.  The first image (A) shows a small disc bulge in the bottom 1-2 joints.  The second image (B) shows disc bulges at multiple levels of the spine with compression of the spinal cord and nerves that innervate the leg.

 B - Multi Level Disc Bulges
A - 1-2 Disc Bulges

Now that you have seen those pictures, I’ll briefly tell you their story.  Image “A” belongs to a 32 year old man with a small disc bulge on MRI and this small bulge has lead to severe back and leg pain which is debilitating.  This patient has missed work for multiple months out of the year secondarily to pain.  Image “B” shows a spine with severe degeneration and multiple disc bulges.  This is an image of a 62 year old.  This man has no pain and regularly hikes all around the world as a hobby.  



Once again we can see that the MRI does not tell the whole story.  Do not let that next MRI harm you!

          1.  http://blog.myphysicaltherapyspace.com/2011/11/education-to-avoid-harm.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+EvidenceInMotion+%28Evidence+In+Motion%29
          2.   J Orthop Sports Phys Ther 2011;41(11):838-846, Epub 3 June 2011. doi:10.2519/jospt.2011.3618

Thursday, December 15, 2011

What is My BMI?

When I ask my patients or clients what their height is, I get a quick response.  When I ask them their weight I get a hesitated response but I do get a number.  When I ask these same people what their body mass index (BMI) is I get blank stares of uncertainty.   BMI is a good and reliable screening instrument of body fat for people.  A reliable tool is one that actually measures what it is meant to measure.  BMI is calculated by comparing weight and height. 

To calculate your BMI you will need your weight in kilograms and your height in meters.  The equation is as follows:

BMI = weight (kg) / (height (m))2

I’ll give you a second to calculate that …



Ok, BMI ranges fall into these categories:
·         18.49 or less = underweight
·         18.5 to 24.99 = normal weight
·         25 to 29.99 = overweight
·         30 to 39.99 = obese
·         40 and higher = morbidly obese

Some disparities need to be noted.  “At the same BMI, women tend to have more body fat than men. At the same BMI, older people tend to have more body fat than younger adults.  Highly trained athletes may have a high BMI from increased muscularity rather than increased body fatness.”1 

These numbers can serve as a good guideline for your overall health.  Those who have higher BMIs or are overweight are at higher risk for many health problems involving the joints, lungs, and heart.  If you found your BMI to be higher than you expected you should talk to your physician about a diet and exercise plan.  Exercise, such as the group fitness classes at Hayashida and Associates, has proven to lower BMI while improving overall health.  Do I smell a New Year’s Resolution?

1. Anthem Healthy Solutions - 2011 - Issue 01