Why is my MRI negative ?

[Mathew-Estevez]

  I am a twenty six yo male who injured lower back three months ago after vioolently bending and twisting.  After 8 weeks of rest at home, minimal activity and Mckenzie exersize back and leg pain diminished. At that point I still had symptoms therefore choose to undergo an MRI. AT the time of MRI leg numbness and tingling was absent.  The results were negative for herniated discs in back.  My current physical therapist believes it is a nerve root lesion.  I disagree because my symptoms seem to increase in certain positions especially sitting. I know this increases intradiscal pressure that may cause a healing herniation to be aggravated. My gut believes its a herniation, I want to believe the therapist because that seems more hopeful.  I am sick of not knowing what this is .  Should I be objective and trust the MRI read as a 100% reliable.  Why do symptoms continue after so long?  A nerve lesion could not be that troublesome.  Books say a disc can be though. Should I get an MRI when I am in pain and Symptomatic or is that a waste of time.  I am seeing a neurologist on monday March 1 what should I tell him?  To order another MRI or is there another more effective diagnostic test?  Desperately seeking feedback I've lost work, social life and this is effecting my emotional well being now.  P.S I just grad from P.T. school so you don't need to use laymens terms
  email ***@****
  Thanks
  Matt

[CCF NSG MD / gsh]

_
Dear Matthew,
The most important thing to remember here is that there are many causes for back pain.  An MRI is a highly sensitive test for disc herniation as it shows in great detail the anatomy of the area and is unlikely to miss a significant disc herniation if it was a good study.  It is possible that the films were misread, but doubtful that the study itself would miss the lesion if present.  
Unless your symptoms have changed significantly, another MRI is probably not going to contribute in any meaningful way to your present care.  Other causes of pain can be that from musculoskeletal origin as well as injuries to the nerves further away from the spinal canal, which don't necessarily show up on the MRI.  
If your pain persists, a reasonable study may be an EMG.  This study would add electrophysiological evidence to any kind of nerve compression.  If none were found, your physician would likely recommend further conservative treatments like physical therapy and NSAIDS.  Have a chat with your physician and see whether this isn't a reasonable course of action.
Good luck.