“I need an MRI to know what's wrong with my back”
By Matheus de Paiva, Exercise coach, BSc Physical Therapy, MSc Rehabilitation Science. Updated 2026-10-03.
For most back pain without warning signs, an MRI does not change treatment or outcomes. Guidelines recommend imaging only when there are red flags or when surgery is being considered.
What the research shows
A review of trials comparing routine imaging with usual care for low back pain found no improvement in pain or function when scans were done without a clear reason.
Because scans often show changes that are also common in people without pain, they can lead to worry, more tests and treatments that do not help.
When imaging makes sense
- Unexplained weight loss, fever or a history of cancer
- New weakness, numbness or loss of bladder or bowel control
- Significant trauma
- Severe pain that does not improve and surgery is being considered
Common questions
Wouldn't it be better to know what I have?
It is natural to want a name for your pain. For most chronic back pain, the useful answer is a plan: what to do, how much and how to progress. Your doctor rules out warning signs first.
Sources
- Chou et al. 2009, imaging strategies for low back pain (The Lancet)
- NICE guideline NG59, low back pain and sciatica
- Choosing Wisely Canada
These guides are general education and do not replace advice from your doctor or health team. True Pace does not diagnose or treat medical conditions.