Month: September 2025

Back pain can be frustrating, limiting, and disruptive to daily life. For some, it’s an occasional ache that goes away with rest; for others, it lingers or worsens over time, causing significant concern. Back pain can arise from issues in the lumbar spine, including conditions like sciatica, spinal stenosis, or a herniated disc.

One of the most valuable tools doctors use to uncover the root cause of persistent pain is magnetic resonance imaging (MRI). The benefits of MRI include providing detailed images that help with accurate diagnosis and effective treatment planning. But not every patient with back pain automatically needs an MRI. Knowing when to seek this diagnostic scan—and what red flags to watch for—can guide patients toward timely care and the right treatment plan. Guidelines from organizations such as the American College of Physicians recommend MRI only when certain criteria or red flag symptoms are present, ensuring appropriate use of imaging for back pain.

Introduction to Back Pain Diagnosis

Back pain is one of the most common health concerns, affecting millions of people and often interfering with daily activities and overall quality of life. Diagnosing the source of back pain can be challenging, as it may result from a variety of causes such as injuries, degenerative changes, or even infections. Magnetic resonance imaging (MRI) scans have become an essential tool in the evaluation of back pain, especially when it involves the lumbar spine. An MRI scan uses powerful magnets and radio waves to create detailed pictures of the spine, allowing physicians to see the soft tissue structures—including the spinal cord, nerves, and discs—that are not visible on standard X-rays. This advanced imaging helps doctors determine the underlying cause of pain, whether it’s a herniated disc, nerve compression, or another issue, and develop a targeted treatment plan to improve patients’ health and quality of life.

Understanding Red Flags

Most cases of acute back pain improve with rest, stretching, or conservative treatment. However, there are certain “red flags” that signal something more serious may be happening in the spine.

Red flags that may warrant an MRI include:

• Severe or progressive neurological symptoms (numbness, weakness, or loss of bladder/bowel control)
• Fever combined with back pain (possible infection)
• A history of cancer with new back pain
• Significant trauma or recent accident
• Unexplained weight loss alongside chronic back pain

When these symptoms appear, they require urgent evaluation. Doctors also consider risk factors such as age, medical history, and medication use to determine if advanced imaging is necessary. An MRI can help detect conditions like spinal cord compression, fractures, infections, or tumors in the spine that may require immediate intervention.

Symptoms of Low Back Pain

Low back pain can present in a variety of ways, ranging from a sudden, sharp discomfort known as acute low back pain to a persistent, ongoing ache that characterizes chronic low back pain. Common symptoms include pain in the lower back, which may radiate to the buttocks, thighs, or even down the legs. Some patients experience numbness, tingling, or weakness in the legs, which can signal nerve involvement. In more severe cases, symptoms such as loss of bowel or bladder control, fever, or a history of recent trauma may appear—these are considered red flags and require immediate medical attention. Sciatica, a frequent companion of low back pain, occurs when the sciatic nerve is compressed or irritated, leading to pain, numbness, or tingling that travels down one or both legs. Recognizing these symptoms is crucial for timely diagnosis and effective treatment.

Diagnostic Tools for Back Pain

Doctors use several tools to evaluate the spine. X-rays are often the first step, useful for detecting fractures or alignment issues. Computed tomography (CT) scans provide more detail and have traditionally played a significant role in spinal imaging, but expose patients to radiation.

MRI, by contrast, offers the most detailed view of soft tissue structures—discs, ligaments, spinal nerves, and the spinal cord itself—without radiation. Spinal imaging includes various modalities, but spinal MRI is the most advanced procedure for evaluating soft tissues and diagnosing spine-related conditions. This makes it especially helpful for diagnosing:

• Herniated discs causing nerve irritation
• Spinal stenosis narrowing the spinal canal
• Degenerative disc disease leading to chronic back pain
• Spinal deformities, infections, or tumors, for which spinal MRI is the preferred procedure

In complex cases, multiple MRIs (mris) may be performed to monitor changes or guide treatment.

For many patients with persistent or worsening back pain, an MRI provides the clarity needed to move forward with a treatment plan, whether that means pain management or a surgical option such as minimally invasive spine surgery. Diagnostic tests, including imaging procedures and laboratory tests, are used to rule out serious causes of back pain.

The Lumbar Spine and Low Back Pain

The lumbar spine is one of the most common sources of pain. The spinal column, composed of five vertebrae and cushioning discs, supports the body and protects the spinal cord while bearing much of the body’s weight and enabling movement. When these discs become damaged or compressed, they can cause radiating pain, numbness, or weakness in the legs.

MRI scans of the lumbar spine are particularly effective for uncovering:

• Disc herniations
• Stenosis causing nerve compression
• Spinal deformities affecting posture and function

It is important to note that degenerative changes, such as dehydrated discs, are often observed in asymptomatic patients, so imaging findings should always be correlated with clinical symptoms.

Patients with mild, short-term low back pain may not need imaging at all. But for those whose symptoms persist or worsen, MRI helps pinpoint whether the issue is muscular, structural, or neurological. A systematic review supports the use of MRI for accurately diagnosing specific lumbar spine conditions.

Causes of Low Back Pain

Low back pain can arise from many sources. Acute pain may develop suddenly after lifting or a fall. Chronic pain often stems from gradual changes, such as degenerative disc disease or arthritis.

Other causes include:

• Pinched nerves from compressed spinal structures
• Spinal cord compression from injury or deformity
• Infection or cancer, which require urgent evaluation

Because the causes are so varied, a careful medical history and physical exam come first. If concerning features are found, imaging—especially MRI—becomes essential to help determine the underlying cause of back pain. MRI can help diagnose specific conditions, such as ankylosing spondylitis or nerve compression, that may require different treatment approaches. MRI findings also help physicians decide how best to treat the patient’s symptoms.

Conservative management is often the first step. Exercise is frequently recommended as an initial treatment for low back pain, as it can provide temporary relief and improve symptoms.

Preparing for a Diagnostic Procedure

Before having an MRI scan, it’s important for patients to communicate openly with their doctor about any metal objects or implants they may have, such as pacemakers, artificial joints, or cochlear implants, as these can affect the safety and quality of the imaging. All metal items, including jewelry, watches, and eyeglasses, should be removed prior to the scan. In some cases, a contrast dye may be used to enhance the images, so patients should inform their doctor about any allergies or sensitivities. The MRI technologist will provide instructions and support throughout the procedure, ensuring patients remain comfortable and still to obtain the most accurate images. Additionally, patients should be ready to share a detailed medical history, including any previous injuries, surgeries, or relevant health conditions, to help the medical team tailor the imaging and interpret the results effectively. This preparation helps ensure a smooth experience and the best possible outcome from the MRI scan.

What to Expect During an MRI Scan

The MRI procedure is simple and non-invasive. Patients lie on a table that slides into the scanner, which uses powerful magnets and radio waves to create detailed images.

• The scan usually takes between 20 minutes to an hour.
• Metal jewelry, watches, or glasses must be removed beforehand.
• Leg braces or other external devices may need to be removed before the procedure.
• In some cases, a contrast dye may be used to highlight certain tissues.
• The technologist monitors the patient throughout, providing instructions to stay still and comfortable.

While MRI is generally safe, patients with certain metal implants may require alternative imaging. Your physician will determine if MRI is the right choice. However, it is important to be aware of potential risks, such as magnetic interference with implants, allergic reactions to contrast dye, or other complications that may arise during MRI procedures.

Next Steps for Back Pain Patients

Not every backache requires advanced imaging, but when symptoms persist, worsen, or present with red flags, an MRI can be a critical step in getting answers. Timely and appropriate imaging can improve patient outcomes by guiding effective treatment. Accurate diagnosis is the key to effective treatment and long-term relief.

At ISSI, we help patients by determining when imaging is appropriate and guide them through next steps. If you’ve been struggling with unresolved back pain, start today with our Pain Assessment Tool or request a Free MRI Review to see if advanced imaging could help you.

Pickleball is a dynamic sport that blends the best elements of tennis, badminton, and table tennis, played on a badminton-sized court with lightweight paddles and a perforated plastic ball. Its easy-to-learn rules and social atmosphere have made it a favorite among people of all ages, fueling the sport’s popularity across the country.

However, as more pickleball enthusiasts take to the courts, there has been a noticeable rise in pickleball-related injuries. Common pickleball injuries include overuse injuries such as pickleball elbow (lateral epicondylitis), rotator cuff injuries, and strains to the Achilles tendon. Soft tissue injuries and even fractures can occur, especially when players push themselves too hard or use improper technique.

Understanding the risks associated with playing pickleball is the first step toward injury prevention. By focusing on proper technique, incorporating thorough warm-up routines, and finishing with cool-down stretches, players can significantly reduce their risk of injury and maintain their physical fitness. Recognizing common symptoms early and seeking appropriate treatment can also help prevent minor issues from becoming major setbacks.

Whether you’re a seasoned pickleball player or just starting out, learning about common pickleball injuries, their symptoms, and effective treatment plans will help you stay active and enjoy the game safely. With the right approach, you can benefit from all that pickleball has to offer while minimizing the risk of injury.

Common Injuries in Pickleball

Although pickleball is played on a smaller court than tennis, its quick movements, twisting motions, and repetitive strokes can create strain. Overuse injuries such as pickleball elbow and rotator cuff irritation are common, along with ankle sprains and even fractures from falls. Falling is a common mechanism of injury in pickleball, often leading to fracture of various bones, including the heel bone, and injuries to the head. Pickleball related fractures frequently occur during play, and many of these injuries result in visits to emergency departments for assessment and care.

Common injuries also include joint, muscles, and shoulders injuries, which can result from repetitive motions and overuse during play.

The spine is particularly vulnerable. Sudden lunges and lateral movements can cause a herniated disc or nerve compression, leading to radiating pain known as sciatica. In older adults, the stress of play may also aggravate spinal stenosis, a narrowing of the spinal canal that can cause leg pain and limited mobility.

When symptoms such as persistent back pain, numbness, or tingling develop, they are often signals that the spine needs attention before the condition worsens. Discomfort is a common early sign of injury, and injuries can affect movement and function. A physical exam is often the first step in diagnosing injuries, and a personalized treatment plan is important for recovery.

For initial care of minor injuries such as a sprain, the rice method is an effective approach to reduce pain and swelling.

Other factors such as age, bone health, and physical activity levels contribute to injury risk. Orthopaedic surgeons are seeing more patients with pickleball-related injuries, and being injured can lead to time away from the sport.

Prevention should focus on addressing potential injury by using proper technique and preparation. Many injuries occur as a result of sudden movements, falls, or repetitive motions during play.

Risk Factors and Prevention

Certain groups are more likely to sustain injuries. Older players, those with existing back problems, and individuals with reduced bone density face greater risk. A family history of fractures or osteoporosis can also increase risk and may require earlier bone health screening. Poor technique and lack of warm-up routines also increase the likelihood of injury.

The good news is that many injuries are preventable. Players can protect themselves by:

• Performing warm-up and cool-down stretches before and after play
• Wearing supportive court shoes with good grip and stability
• Using a lighter paddle to reduce shoulder and elbow strain
• Staying hydrated and pacing activity with regular breaks

Even small adjustments in preparation and technique can greatly reduce the strain placed on the spine.

Reducing Risk Factors for Older Adults

Older adults are among the fastest-growing groups of pickleball players, but they also face unique risk factors when it comes to pickleball-related injuries. Age-related changes such as decreased muscle strength, reduced flexibility, and underlying health conditions can make older adults more prone to overuse injuries, soft tissue injuries, and fractures.

To prevent injuries and maintain physical fitness, it’s important for older adults to adopt a proactive approach. Incorporating gentle warm-up routines, stretching exercises, and cool-down stretches before and after playing pickleball can help prepare the body for activity and reduce the risk of muscle strains and other common injuries. Using a lighter paddle and wearing supportive footwear designed for court sports can also minimize stress on the joints and soft tissues.

Playing on surfaces with adequate cushioning and good traction further reduces the risk of falls and related injuries. Older adults should listen to their bodies, take regular breaks, and avoid playing through pain or fatigue. Consulting with a healthcare provider or sports medicine specialist can provide valuable guidance, helping to develop a personalized exercise and injury prevention plan tailored to individual needs and health status.

By taking these steps, older adults can continue playing pickleball safely, enjoying the physical, social, and mental health benefits of the sport while minimizing the risk of injury. Staying active and engaged is possible at any age with the right preparation and attention to injury prevention.

Why Spine Health Matters

Pickleball places frequent stress on the lumbar spine due to twisting, bending, and sudden side-to-side movements. These forces can accelerate degeneration of the discs and joints, increasing the risk of conditions such as lower back pain or a pinched nerve.

Core strength is one of the best defenses against spinal injury. Exercises such as side planks, gentle bridges, and rotational stretches help stabilize the back and protect against excessive stress. For individuals with degenerative disc disease, maintaining spine health through conditioning is especially important.

Playing Safely on the Court

A safe environment and smart habits make a big difference. Courts should have smooth surfaces and proper lighting to reduce fall risk. Proper footwear, lightweight equipment, and breathable clothing all contribute to both comfort and injury prevention.

Players should also stay aware of their surroundings—uneven ground, loose balls, or crowded spaces can all lead to falls. Combining awareness with strong safety habits ensures the game stays enjoyable rather than painful. For additional guidance, ISSI’s earlier post on pickleball and back pain provides more practical strategies.

When to Seek Medical Care

Soreness after a match is normal, but ongoing pain or neurological symptoms should never be ignored. Warning signs that it’s time to consult a specialist include:

• Pain that does not improve with rest
• Numbness, tingling, or weakness in the arms or legs
• Difficulty standing or walking for extended periods

If you experience any of these symptoms, it is important to consult doctors for proper diagnosis and treatment of pickleball-related injuries.

Treatment options may range from physical therapy and targeted pain management strategies to advanced procedures such as minimally invasive spine surgery for more serious conditions. Early diagnosis and treatment not only improve recovery but also allow players to return to the court sooner.

Protect Your Spine, Enjoy the Game

Pickleball provides social connection, fitness, and fun, but protecting your spine is essential for long-term participation. With proper preparation, safe technique, and attention to early warning signs, players can reduce their risk of injury while enjoying all the benefits this fast-growing sport has to offer.

If you are experiencing back pain after playing pickleball, take the first step toward relief. Start with ISSI’s Pain Assessment Tool or schedule an appointment with a spine specialist today.