The objectives of a Physical Medicine & Rehabilitation consultation:

1) Detect dangerous conditions.

2) Identify barriers to success or risk factors for chronic disability.

3) Utilize diagnostic tests efficiently.

4) Initiating appropriate treatment.


Physical exam and radiographic studies may identify opportunities for procedural interventions or surgery, but these findings often do not correlate with symptom severity, degree of disability or appropriate intensity of treatment. [IID]*

Imaging Studies

Patient Education: MRI
 
Video MRI - What to Expect

Low Back Pain
ACUTE: X-rays, MRI, or CT scan are not recommended for routine evaluation within the first 4-6 weeks of symptoms unless a red flag and high index of suspicion is noted on clinical evaluation.If radicular pain without weakness does not improve by > 3 weeks obtain MRI [IIB*]. If not diagnostic, obtain EMG. 
CHRONIC: 30% of asymptomatic volunteers have disk changes on MRI. Neither the radiologist's report of 'stenosis' nor measures of the spinal canal on imaging are useful in positively diagnosing the clinical syndrome of spinal stenosis. Low-grade spondylolisthesis noted on x- ray are most often asymptomatic. In these cases diagnostic tests must be interpreted in conjunction with the clinical history and physical examination.