Stop Getting MRIs For Low Back Pain (Do This Instead) | Dr. Justin Farnsworth #450

Summary

Dr. Justin Farnsworth argues that uncomplicated low back pain often does not require an immediate MRI or a complicated treatment plan. Many MRI findings, such as disc degeneration, also appear in people without pain, so scan results should be interpreted alongside symptoms and a clinical assessment. For non-specific low back pain without concerning signs, he says most people improve within four to six weeks. Reassurance and staying active are often more useful than treating every scan finding as damage.

Key strategies and advice

• Reassure, then keep moving. Pain is real, but it does not automatically mean the body is being harmed. For ordinary back pain, modify activities that aggravate symptoms rather than stopping all movement.
• Use imaging selectively. Early imaging for uncomplicated back pain may reveal common age-related changes that increase fear and discourage activity. Seek prompt professional assessment for serious symptoms, such as new loss of bladder or bowel control, foot drop, or significant neurological problems.
• Adjust training to the person and their response. Decide whether to train through, around, or temporarily away from an injury based on the tissue involved, the person’s function, the activity being considered, and how symptoms respond during the session and afterward.
• Use pain as one guide, not a verdict. Farnsworth’s general traffic-light framework for relatively simple musculoskeletal problems is:
  • 0–4/10: Generally green; activity may be reasonable if it is tolerable.
  • 5–6/10: Yellow; slow down or adjust a variable such as load, volume, or range of motion.
  • 7+/10: Red; avoid that painful activity for now.
  • Check the response over the next 24–48 hours. If symptoms remain elevated beyond that, reduce the dose. These are broad guidelines, not rules for every injury or tissue.
• Build capacity, not just pain avoidance. Manage weekly workload and include strength, movement in multiple directions, and some power work appropriate to the person’s current ability. Farnsworth also recommends attending to sleep, nutrition, stress, and daily activity.
• Use exercise variations that fit the person. Single-leg work, lateral lunges, supported squats, machines, and other variations can make it possible to train around pain or mobility limits while still challenging the muscles. The barbell back squat is an option, not a requirement for everyone.
• Progress power work gradually. Small doses—such as a few medicine-ball throws, low-level jumps, or other suitable drills—can be added to a warm-up. Establish basic strength and coordination first; don’t copy demanding sprint or plyometric routines without the preparation for them.
• Load the back as capacity allows. Farnsworth favors progressive posterior-chain strengthening for many people with chronic low back pain. He recommends first noticing which positions feel better or worse, then using tolerable variations and gradually reintroducing less comfortable positions. He cautions against treating spinal flexion as inherently dangerous; progression matters.
• Treat tools as options, not cures. A reverse hyper may suit some people, but it is not a universal fix. Use a variation that feels appropriate, avoid relying on uncontrolled momentum, and stop or modify it if it worsens symptoms. The conversation notes that extension-heavy work may not suit everyone, including some people with spinal stenosis.
• Build mobility through active, controlled movement. Farnsworth emphasizes strength training through a person’s available, controllable range of motion. Static stretching and manual treatments may temporarily make movement feel easier, but he describes loading the newly accessible range as the longer-term step.
• Respect individual anatomy and history. Posture or asymmetry alone does not establish the cause of pain. Assess whether a position or movement is actually relevant to the person’s symptoms and goals, and adapt technique or stance when appropriate.
• Use specialized rehabilitation methods with guidance. The discussion describes blood-flow-restriction training as a possible way to train with low loads when heavier loading is not tolerated. Farnsworth stresses using a suitable cuff that measures occlusion and following an evidence-informed protocol rather than improvising with tight bands.
• Individualize plans for cardiac conditions or joint replacements. The speakers recommend discussing training limits with the relevant physician. For people taking beta blockers, they mention perceived effort and the talk test as practical alternatives to relying on heart rate alone. After knee replacement, Farnsworth emphasizes restoring full knee extension as well as bending. After hip or knee replacement, loading and impact should be built up progressively.

Presenters and sources mentioned

Presenters

• Dr. Justin Farnsworth — guest
• Dave Tate — host
• Tom — co-host/panelist; surname not stated in the subtitles

Sources and resources referenced in the discussion

• Taryn et al., 2021 — systematic review comparing posterior-chain strengthening with general core and walking programs for chronic low back pain; citation details were unclear in the subtitles.
• Journal of Orthopaedic & Sports Physical Therapy (JOSPT), 2019 — article discussed in relation to factors associated with chronic pain; exact citation not provided.
• International Journal of Sports Physical Therapy (IJSPT), 2019 — foam-rolling discussion; exact article not provided.
• A 2015 study of MRI findings in people without back pain — discussed, but the exact study was not named.
• British Journal of Sports Medicine (BJSM) — referenced in a discussion of sham-surgery research; specific studies were not identified.
• Lane Norton and Kelly Starrett — quoted or paraphrased during the conversation.
• Meric Health, Element, MASS Research Review, and EliteFTS — mentioned in sponsor or show promotions.