Do I Need an MRI Before Seeing a PT? (Spoiler: Probably Not)

If you’re experiencing pain—whether it’s in your back, knee, shoulder, or anywhere else—you might be wondering if you need an MRI before seeing a physical therapist. After all, many people assume that imaging is the first step to understanding what’s wrong. But here’s the truth: in most cases, you don’t need an MRI before starting physical therapy—and waiting for one might actually delay your recovery.

At Nashville Physical Therapy & Performance, we believe in empowering you to take control of your health early, with personalized movement-based care that often makes imaging unnecessary.

Why Do People Think They Need an MRI First?

MRIs have become a common tool to “look inside” the body and detect injuries or abnormalities. They’re excellent at showing structural details like disc herniations, ligament tears, or joint changes. Because of this, many people and even some healthcare providers believe an MRI is essential before any treatment can begin.

However, MRIs are often overused, and the findings don’t always tell the whole story. Many people have abnormalities on their MRI but no pain at all (Brinjikji et al., 2015). This means that an MRI can sometimes show things that aren’t actually causing your symptoms.

Why Physical Therapists Often Don’t Need an MRI to Start Treatment

Physical therapists are movement specialists trained to assess your symptoms, movement patterns, strength, flexibility, and functional limitations to determine the cause of your pain. Through a thorough physical exam, PTs can often identify the source of your problem and create an effective treatment plan without waiting for imaging.

Here’s why early PT without an MRI makes sense:

• MRI findings may not change your treatment plan. Whether or not an MRI shows a disc bulge or mild arthritis, many treatment principles—like strengthening, mobility work, and posture correction—remain the same (Chou et al., 2009).

• Early intervention improves outcomes. Waiting for imaging can delay therapy, leading to prolonged pain and dysfunction (Foster et al., 2018).

• Cost and accessibility. MRIs can be expensive and require referrals and insurance approvals, creating unnecessary barriers.
  

When Might You Actually Need an MRI?

There are certain red flags or signs that suggest imaging is necessary before or during PT, including:

• Significant trauma or injury (e.g., car accident, fall from height)

• Severe or worsening neurological symptoms (e.g., numbness, weakness, bowel/bladder changes)

• Suspected fracture, infection, or tumor

• Symptoms that don’t improve after a reasonable trial of physical therapy
  

Your physical therapist will monitor your progress closely and refer you for imaging if needed.

How Nashville PT Approaches Your Care

At Nashville PT, we prioritize getting you moving and feeling better as soon as possible. Our cash-based model means you won’t face insurance delays—so you can book a thorough one-on-one evaluation with a skilled PT right away.

We combine:

• A detailed movement and functional assessment

• Hands-on examination and tests to identify pain sources

• Personalized treatment plans with hands-on therapy, exercises, and education
  

If imaging is needed, we’ll guide you through the process and collaborate with your healthcare providers to ensure the best outcome.

The Bottom Line: Don’t Wait on Imaging—Start Moving

If you’re experiencing pain or movement problems, don’t wait for an MRI to get help. Early physical therapy can reduce pain, improve function, and often prevent the need for costly imaging or invasive procedures.

At Nashville Physical Therapy & Performance, we’re ready to help you start your recovery journey with personalized, expert care—no referral or MRI necessary. Call us today to schedule your evaluation and take the first step toward feeling your best.

References:

• Brinjikji W, Luetmer PH, Comstock B, et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173

• Chou R, Qaseem A, Snow V, et al. “Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society.” Ann Intern Med. 2007;147(7):478-491. doi:10.7326/0003-4819-147-7-200710020-00006

• Foster NE, Anema JR, Cherkin D, et al. “Prevention and treatment of low back pain: evidence, challenges, and promising directions.” Lancet. 2018;391(10137):2368-2383. doi:10.1016/S0140-6736(18)30489-6