The Butterfly Effect and Back Pain - Why a MRI in most cases is a Waste of Money

In chaos theory, the Butterfly Effect refers to the concept that small causes can have large profound effects.

The same can be said about the management and treatment of low back pain.

At any point in your journey of experiencing back pain- from onset of pain to rehab and recovery, it has been well researched that how or what you are diagnosed with coupled with what your therapist even says can change how you recover.

Here are some facts:


Fact 1:

“Radiological imaging for low back pain in the absence of red flags, neurological deficits and traumatic injury is not warranted and may in fact be detrimental”

The prevalence of disc degeneration/bulges/protrusion on imaging increases with age whether you have pain or not [1]… basically, it’s going to show you exactly what you see on your face; Normal age-related changes…wrinkles and all.

Hearing those words however, can psychologically put you at a disadvantage when it comes to recovery. We start to think that our backs are weak, vulnerable and that pain= ‘more damage’.

Getting an MRI for your back in the absence of any indicators* for imaging is also an unnecessary waste of money because here’s a secret I’ll share with you….it doesn’t change how we treat you!

So save your pennies and your time. You don’t need an MRI.

*said ‘indicators’ are picked up by a good thorough assessment and only really accounts for 5% ofcauses for low back pain.


Fact 2:

“The spine is flexible and is designed to move. If bent around, it can bend far enough to make two thirds of a circle.”

Being told that you have to ‘protect’ the back and not bend or twist when you have pain is, in my opinion utter bullsh*t. If it were meant to “not move” then the spine would be designed like your legs or arms- a series of shaft bones with specific hinge points. Instead it is a segmented structure with over 120 muscles and 220 individual ligaments. It’s anatomically designed to twist, bend, rotate and bear load. 

The most commonly used treatment of choice of back pain is to do “core exercise” because you know, your spine needs more stability right?

This concept suggests that your spine is unstable. But guess what? Your vertebrae really isn’t swimming around in your trunk or giving way. There is actually no research to suggest that this is what causes pain. There is also no positive evidence to support so called ‘core exercises’ as being superior to any other form of exercise [2].

The notion of improving spinal stability or holding neutral position is in fact creating a culture of fear avoidance behaviour in that people feel that unless they are in neutral spine or have their core switched on, that they cannot bend, twist or lift things. Fear avoidance behaviour then creates movement patterns that reflect grippy-ness, spasm and poor eccentric control…most likely a contributor to your pain rather than an unstable spine!

We are not Robots...

We are not Robots...

Another caveat: I’m not saying that you shouldn’t maintain good technique and positioning when deadlifting or doing KB swings etc.. but consider training and loading in other ways too. That way, should you happen to flex your spine ever so slightly in that very last rep of a heavy deadlift, you are not going to fall into a heap on the floor!

Do some Jefferson curls- they are one of my favs!


Fact 3

“You can and should deadlift”

No, really…. And while you’re at it, throw in some squats.

Strength training and loading is king. Why?

I’ll use the deadlift as an example. It is an amazing exercise to improve posterior chain strength and more often than not, a weak posterior chain is a contributing factor to why you are experiencing pain. You see, weak muscles have to work harder, therefore they are more prone to fatigue, tension and tightness so it’s a no brainer that you should strengthen them.


Not sure how this is even possible? Come chat to us, we’ll show you how.


Fact 4

“There’s more to back pain than just muscles and joints”.

Factors such as poor sleep, stress, depression and anxiety have been shown to be strong predictors for low back pain [3]. Back pain should be approached more holistically than just what you can and can’t do physically because of pain. Meditate, see a psychologist, change that job you’ve always talked about leaving because you hate it…whatever it is, if it’s contributing to your stress, it’s also contributing to sensitising spinal structures via the central nervous system.

Obviously seek appropriate professional advice if you think there may be something else contributing to your pain. We can only help with the rehab bit!


Fact 5

“Language surrounding your recovery plays a huge part in whether you will get better or not”.

What your health practitioner says to you….actually, what YOU say to YOURSELF can influence your outcome[4, 5].  Numerous studies have shown that sufferers of back pain who have thoughts along the lines of “this is something I’ll have for the rest of my life” or “I have to be careful from now on” are least likely to make full recovery [3].


Final thoughts:

Back pain research has certainly done a massive turnaround in the last decade…certainly since I’ve been at uni. If you’re still being sent off for MRIs, told to do core exercises only and not bend your back then your practitioner needs to get up to speed. You can do them a favour and send them along to google to look up these dudes (some gurus in the field)- Peter O’Sullivan, Greg Lehman and Lorrimer Moseley.  

If you want a fresh approach to finally get rid of your back pain…Come and see us here at Evolutio Sports Physio in Richmond

Jac is is one of the best known Physio's out in the Melbourne Sports and CrossFit market. She comes from an experienced background in Sports Physiotherapy through many years working in London and Melbourne.

She has a wicked eye for Analyzing Movement and Biomechanics. 

Jac works at Evolutio in Richmond, Melbourne clinic Mon - Thurs

Bookings with Jac can be made here




1.         Brinjikji, W., et al., Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol, 2015. 36(4): p. 811-6.

2.         Smith, B.E., C. Littlewood, and S. May, An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders, 2014. 15(1): p. 416.

3.         O'Sullivan, P. and I. Lin, Acute Low Back Pain: Beyond Drug Therapies. Pain Management Today 2014. 1(1): p. 8-13.

4.         Darlow, B., et al., The enduring impact of what clinicians say to people with low back pain. Ann Fam Med, 2013. 11(6): p. 527-34.

5.         Main, C.J., N. Foster, and R. Buchbinder, How important are back pain beliefs and expectations for satisfactory recovery from back pain? Best Practice & Research Clinical Rheumatology. 24(2): p. 205-217.