Understanding how diagnostic imaging techniques contribute to your plan of care

Understanding how diagnostic imaging techniques contribute to your plan of care

By Dr. Daniel Walden, PT, FAAOMPT, IRG physical therapist

You've just hurt your knee playing tennis and aren't sure what is the next step in the recovery process. Should you wait several weeks to see your physician and possibly get imagining or start today with a physical therapy evaluation?

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People often look at the diagnostic images from referring doctors as a (mistakenly) magic bullet. “If the image says this (insert diagnostic finding here), then I need this (insert surgical, pharmaceutical, or other intervention here)!” If that were the case, then all medical providers would need to do during an evaluation is send a patient for imaging, and the treatment process would be far less convoluted. The challenge is that the images are only a part of the puzzle. They don’t always indicate what the best treatment is: treatment must be put together using the other details of a person’s physical history, basic demographics and functional abilities. Using these other aspects can help us develop an appropriate plan of care that is effective, affordable and time efficient. That said, the plan should strive to be minimally invasive until absolutely necessary. Imaging can help keep treatment options minimally invasive. Here are the most popular types of imaging that can help physical therapists and medical doctors work together to help patients heal.

X-rays

When it comes to X-rays (radiographs), we are generally using them to assess bone integrity after a traumatic event or observing lungs for breathing difficulties. When we check for bone breaks, it is often for non-life-threatening care that is not time sensitive. In non-life-threatening scenarios, we check for whether fractures are stable or not. Unstable fractures typically require casting or internal fixation so the bone can heal appropriately for full restoration of the adjoining joint articulation. In other words, it is fixed into place during the healing process so it will still move within the joints the way it was designed to.

MRI Scans

When it comes to magnetic resonance imaging (MRI) scans, the images are most often for soft tissue damage, such as muscle, ligament or occasionally soft tissue abnormalities. These are used to determine severity of soft tissue injury and if there is potentially excessive scarring or perhaps tumorous growth, MRIs can reliably catch abnormalities early. In pain states, particularly acute (early in the injury process) or chronic stages (prolonged pain, such as with osteoarthritis), these images can assist with understanding part of the condition, but they will not typically reveal enough information to indicate changes in the basic treatment plan for non-life-threatening medicine. While an MRI can aid in understanding the severity of your injury, it will often not affect the role physical therapy has within your treatment plan unless your desires suddenly change to address your ailment with invasive or alternative care.

An MRI doesn't always provide enough information to dictate specific changes in treatment when it comes to physical therapy, chiropractic, or non-invasive treatment. Waiting for imagery is often something patients do when their pain is highly elevated, close to the date of injury, or they have significant fear around their ailment and are unwilling to move. However, if you are yearning to return to a healthy and healed state and are especially against having surgery, conservative care is your ideal option.

Let’s consider this scenario: using imaging as a part of a treatment plan

Imagine you have new knee pain and are waiting for more information via an MRI scan. Although a scan may provide additional information, starting with physical therapy and gentle treatment can result in better outcomes before you get your imaging results back. MRI or not, increasing circulation via Thermal modalities (heat, such as heating pads) or active interventions are the best early intervention to allow your body’s natural inflammatory response. Swelling or pain may be an early symptom of this phase, and it is great feedback to listen to: such feedback will let your body know its limits and keep you from further injuring it during this phase. By emphasizing circulation in this phase, you will begin to move this affected region more and restore normal motion early. When you can do this, you minimize muscle atrophy and even begin to strengthen the tissues of that region that have been out of use due to pain.

When you restore normal motion and strengthen, you may recognize that your injury wasn’t as severe as originally thought and return to regular function. This is fantastic! Less time lost to the injury, a quicker return to work or sport and fewer medical costs.

But what if the injury or pain is still looming and symptoms are still present? You still may need surgery, and getting imaging done can help determine your candidacy for surgery and potential avenues for healing. By getting a gentle start with physical therapy, you will be approaching surgery with less inflammation, restored motion and stronger muscles, which points towards the best possible outcomes.

Win-win-win! So next time you are referred to radiology or magnetic resonance imaging, don’t just ask yourself if this is completely necessary, inquire with your attending medical provider about what your options are and what you gain from each of them. You and your medical provider can then work together with a physical therapist to help you start feeling better, faster.

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Dr. Daniel Walden, PT, FAAOMPT, is available for telemedicine appointments. You can learn more about IRG’s telemedicine offerings here.