Do I Need An MRI?

“Should I get an MRI?”

Probably a question we get asked every day. There is a lot of certainty that comes with getting a scan and many of our patients experience a sense of relief when we have something definitive and can map our a clear plan based on clear findings..

Here are some reasons we send for an MRI:

• Grading an injury - this helps us manage the time it will take to recover

• Uncertainty - some people just want to know what’s wrong

• It’s not responding as expected - maybe we need to clarify the diagnosis

• Determining the diagnosis - if you can’t tell if it’s one thing or another and the management of the injury depends on the diagnosis

Often though, the answer is not always “yes, let’s get a scan” - and here are 3 strong reasons why…

1. The scan is likely to reveal a lot of information which may not be relevant

2. The pain may be driven by nerve sensitivity rather than a pathology

3. Getting a scan may not help us build a success plan together

When would a scan reveal irrelevant information?

Here’s what we know - normal degenerative changes on scans start to present themselves from the age of 30. So, if you’re 50, and have shoulder pain for example, it’s quite likely for us to see “degenerative tearing” of tendons, “cystic changes in the cartilage” and “osteophytic development”. I’m using the terms in case you’ve got an MRI and those phrases set off alarm bells. They are fairly common and reasonable findings for someone who has used their shoulder for half a decade.

When is something sensitive and when is something pathological?

We have a growing amount of evidence to suggest with certainty, that pain is not structural. Meaning, your pain doesn’t always come from what your scan says. 80% of disc bulges found on MRI are asymptomatic! If your pain follows a pattern that is in line with a pathology then a scan can help diagnose with accuracy - BUT if your pain changes from day to day or follows a pattern that isn’t in line with a particular pathology, then sometimes, the pain can come from something being sensitised. Curious? Watch this post on insta.

When wouldn’t a scan help us plan?

Generally, a scan won’t help us in 2 situations: You’re either already getting better, or we’re just sending for a scan to tell us what we already know. These situations do not indicate sending for a scan.

How do you track progress? Do you reassess regularly?

Something we’ve introduced this year which has helped our patients immensely are our “review sessions”.

What they are is an opportunity for us to debrief what’s gone well and what hasn’t gone quite well - allowing us to adjust accordingly.

This is the process here:

Internally, one of our metrics is how many review sessions we have scheduled. The reason is because it’s absolutely crucial to stay current with our approach in making a difference to your life.

Without these sessions, things can eventually feel a bit directionless…

The reason the sessions can become directionless is simply because we haven’t discovered and agreed on a meaningful enough metric that strongly relates to your problem or to your goal. This can also happen if we have bridged the gap on the metric and did not pivot quick enough to discover the next most important metric - especially if your problem isn’t solved yet.

If your goals have changed, ask us about having a review session. The best relationships are two-way, and we invite you to collaborate with us - we want to do absolutely everything we can to support you in health.

I haven't been doing my exercises, should I cancel my appointment?

We hear it (and feel it) quite frequently - that if you haven’t done your exercises, you can feel guilty. Then what happens is you go into problem solving mode, thinking a good solution to that is to have another week or two up your sleeve so you can get them done… So you call us and say…

”… I haven’t done my exercises so I think I should push back my appointment.”

Here’s 3 reasons why that’s a bad idea:

1. You’re not actually going to do them, if you didn’t do them straight away

2. That doesn’t help you get better faster

3. Part of our role is to help you find the best way forward for you

Here’s why people don’t do their exercises…

• Too time consuming

• Couldn’t remember it properly

• Doesn’t feel right

• Too difficult

• Not the right equipment

• Inappropriate or feels socially awkward

• Didn’t feel effective enough

• Doesn’t seem relevant

• Not clear on sets and reps

Pushing your appointment back a week or two doesn’t remove these barriers. Keep the appointment, tell us what the barrier is, and let us help you find another way forward.

In some cases, it’s also important to know, that part of our role in supporting you is to stop trying to ‘fix it’… Instead, help you maintain things with some periodic treatment to keep things where they are and not letting them slip backwards - essentially kicking the can down the road until you’re ready to take another step forward to solving the problem.

Do I need a referral, and how many sessions will I need?

how many sessions do i need?

The number of sessions required to help you solve your problem varies and is dependant on the simplicity or complexity of your problem. We employ our “3 visit rule” so that we are clear on whether we are making meaningful improvement by the 3rd session.

At the 3rd session we can colaborately set meaningful goals and set up a treatment plan that will achieve these goals in a given timeframe. Alternatively, if you are happy with your progress, you can opt to stop your treatment at anytime. If we are achieving no meaningful change by the third session, your case will need to be escalated either to a senior team member or to a different type of health professional for an opinion.

There are various ways someone can access our services:

Private: Whether your session is rebated with your private health cover or you are full fee paying, you can access our services without a referral

Medicare EPC: In order to access our services and claim under medicare, you will need a referral from your GP for an EPC indicating how many sessions and what type of service. We cannot help you claim under Medicare without a referral. Speak to your GP to see if you are eligable for this type of referral as it is for people with chronic pain (pain for more than 3 months)

Workers Compensation Claims: The first 8 sessions with a practitioner are pre-approved, and you will need a GP referral along the approval of the plan from your cae manager in order to have continued access.

CTP Claims: The first session is pre-approved and all following sessions require a GP referral and an approved treatment plan through your case manager.

DVA: Your GP needs to refer you to access our services and claim under DVA.

NDIS: Self funded patients can access our services.but those that are SIRA managed or managed by a case manager require a referral and dedicated funding for the specific type of service.

Telehealth: For existing patients, we do offer telehealth appointments if required and there is no in-person option.

If you have any further questions or you are not sure which category you fit into, please call us on (02) 98995512 or email us admin@balancehp.com.au

How long will it take to feel better, and what will the process involve?

We are highly conscious of the simple fact that patients would prefer to do other things with their time and money, than continuously come back to the Physio/Chiro for more treatment and rehab.

In short, our goal is to help you solve the problem so we can get you out of the clinic, asap.

Of course, there probably won’t be any suprise when we say, that recovery times depend on the problem and your circumstances… Of course “it depends”… But that’s frankly a weak and underwhelming answer - we can do better.

The best way to answer the question is to be clear and up front about our process.

The initial consultation: 45mins

• Learn about what you’re experiencing and your expectations of us

• Find out what is wrong and why it’s happening

• Provide treatment and see if we can make an immediate change aiming for 20-30%

• In more complex cases, we may need to spend more time figuring out what is happening and why it might be happening which will eat into some of the treatment time.

Our “3 visit rule”:

• This includes the initial consult (45mins) and 2 standard consults (30mins each)

• The purpose of the first 3 visits is simple

  • provide enough meaningful and significant change to verify that what we’re doing is working

  • provide treatment and rehab that is relevent and effective

  • have clear advice on what lifestyle or exercise based activities you need to do more of and less of.

• We have a “3 visit rule” because we want to bring urgency to providing you the results you’re looking for

• You and your practitioner should know by the 3rd session whether you’re on the right track or not and from there you have 3 choices:

  • Stop treatment because you’re happy with the improvement

  • Make a treatment plan and assign goal based milestones that you and your practitioner can work towards over the next 4-6 weeks

  • Have a referral to see someone else either at Balance or externally in order to get the progress you are looking for with your problem.

So, ultimately - it will take 3 visits for you to experience improvement and if not, you might be in the wrong place.

The rest of the plan simply depends on the simplicity or complexity of your problem.