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The Sports Medicine Doctor: ‘Does He Need an MRI?’

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By Andrew W. Gottschalk, M.D., Director of Sports Medicine Champion Orthopedics & Sports Medicine, Cole Memorial Health System

Recently, a high school football player came to see me about a sore ankle. He had sprained the ankle a couple of times in the past, and occasionally it still hurt when he ran or landed hard after a jump.

“Football is his main sport,” his father explained. “We need to do everything we can to make sure he keeps playing at a high level.”

Together, the three of us reviewed the athlete’s medical history, the results of his physical examination, and x-rays of the ankle.

“Doesn’t he need an MRI?” his father asked.

It was a great question. To understand why, let’s talk about sports medicine and techniques for viewing the body.

One of the most common ways to image the body is x-rays. X-rays use low-dose radiation to look past the skin and are useful for looking directly at bones. For the most part, x-rays do not look directly at soft tissues (for example cartilage, ligaments, and tendons). Even so, a good sports medicine doctor can diagnose and treat almost all soft tissue problems using x-rays in conjunction with the medical history and physical examination.

Every time patients have x-rays, they are exposed to small amounts of radiation. In contrast, an MRI (which stands for “magnetic resonance imaging”) does not use radiation. An MRI uses a high-powered magnet to obtain images of the body. As with x-rays, an MRI looks directly at bones but, unlike x-rays, it can also look directly at soft tissues.

The question is: When it comes to sports and musculoskeletal medicine, isn’t an MRI “good” medicine?

The answer is: Not always. More importantly, sometimes getting an MRI has negative consequences.

Why? Often joint pain can be resolved with appropriate rest, stretching and strengthening exercises, and anti-inflammatory medication. Multiple scientific studies have shown that obtaining an MRI unnecessarily or too soon can have negative results. These negative results include being benched needlessly, which is bad sports medicine. Or worse, an MRI can result in unnecessary surgery, which is just plain bad medicine.

“If you want an excuse to operate…just get an MRI,” Dr. James Andrews — one of the country’s most popular sports surgeons — told the New York Times in 2011.

Getting an MRI is certainly appropriate in some situations, though not as often as current culture would have us believe. An MRI may be appropriate when a patient fails to respond to treatment or if significant trauma is involved.

I consider the pros and cons of ordering an MRI on almost every patient I see and take that decision seriously.

When the football player’s father asked me if an MRI was needed, what he was really saying was, “I love my kid, and I want him to get the absolute best treatment available.”

I wanted exactly the same thing.

Andrew W. Gottschalk, M.D., is the Director of Sports Medicine at Champion Orthopedics & Sports Medicine of Cole Memorial Health System and team physician for St. Bonaventure University athletics.

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