Before the MRI, Injection, or Surgery: What Physical Therapy Can Do?
By Dr. John Mishock, PT, DPT, DC
When pain shows up, many people immediately wonder if they need an MRI, an injection, medication, or even surgery. That reaction is understandable. Pain can be frustrating, scary, and disruptive. It can affect how you sleep, work, walk, exercise, play with your children or grandchildren, and enjoy everyday life. But in many cases, the best first step is not the most expensive or invasive one. Often, the smartest first step is a physical therapy evaluation.
What Physical Therapy Actually Does
Physical therapy is not simply “exercise.” It is a comprehensive approach to understanding why pain occurs, how movement is affected, and what can be done to improve function. A physical therapist evaluates joint mobility, muscle strength, posture, balance, flexibility, coordination, nerve sensitivity, movement patterns, and the impact of pain on daily activities. The goal is not just to reduce symptoms temporarily. The goal is to help the person move better, function better, and regain confidence in their body.
Pain Doesn’t Always Mean Damage
This matters because pain does not always mean that something is severely damaged. Many people assume that if they have back pain, neck pain, shoulder pain, knee pain, or arthritis, they need imaging right away. However, imaging does not always tell the full story. A major review published in the American Journal of Neuroradiology found that many people without back pain still had common MRI findings such as disc degeneration, disc bulges, and disc protrusions. In that review, disc degeneration was seen in 37% of pain-free 20-year-olds and 96% of pain-free 80-year-olds. Disc bulges were found in 30% of pain-free 20-year-olds and 84% of pain-free 80-year-olds [Brinjikji et al., American Journal of Neuroradiology, 2015]. In plain English, an MRI can show “abnormal” findings that may actually be part of normal aging and may not be the true cause of pain. That does not mean imaging is never needed. MRI, X-ray, injections, medications, and surgery all have an important place in healthcare.
If someone has major trauma, progressive weakness, loss of bowel or bladder control, signs of infection, cancer history, unexplained weight loss, fracture concern, or worsening neurological symptoms; medical evaluation and imaging may be necessary. The point is not to avoid medical care. The point is to start with the right care at the right time. For many common muscle, joint, and spine conditions, physical therapy can help identify the cause of pain and improve function before a person moves toward more costly or invasive options.
The Research Behind a “Physical Therapy First” Approach
The research supports this “physical therapy first” approach. The Centers for Disease Control and Prevention states that nonopioid therapies are at least as effective as opioids for many common types of acute pain, and that noninvasive and nonpharmacologic approaches can improve pain and function without the serious risks associated with opioids [CDC,2025]. The American College of Physicians also recommends non-drug treatments first for many types of low back pain, including exercise, spinal manipulation, motor control exercise, yoga, tai chi, and multidisciplinary rehabilitation [American College of Physicians, 2017]. These recommendations matter because they shift the conversation away from simply masking pain and toward improving how the body moves and functions.
Physical Therapy is Cost Effective
Physical therapy is also cost-effective. In a large study published in Health Services Research, patients with low back pain who saw a physical therapist as the first point of care had an 89% lower probability of receiving an opioid prescription. A 28% lower probability of receiving advanced imaging, and a 15% lower probability of visiting the emergency department compared with patients who saw other providers first [Frogner et al., Health Services Research, 2018]. Another large study found that early, guideline-based physical therapy for low back pain was associated with significantly lower healthcare use and 60% lower total low-back-pain-related costs over two years [Childs et al., BMC Health Services Research, 2015]. These are not small differences. They show that early physical therapy can reduce unnecessary utilization, lower costs, and help patients avoid a cycle of medications, imaging, repeated visits, and delayed recovery.
The Economic Value Reaches Beyond Back Pain
The economic value goes beyond back pain. A 2023 report from the American Physical Therapy Association found that physical therapy produced net economic benefits across multiple common conditions, including acute low back pain, knee osteoarthritis, carpal tunnel syndrome, stress urinary incontinence, falls prevention, and vascular claudication [APTA, 2023. Economic Value of Physical Therapy in the United States.]. The value came from a combination of improved quality of life, reduced future healthcare costs, and helping people return to normal activity. In other words, physical therapy is not just about saving money. It is about helping people stay active, independent, and productive.
How Physical Therapy Improves Quality of Life
That is the part patients care about most: quality of life. Pain changes behavior. People begin to avoid stairs, avoid lifting, stop exercising, sleep poorly, and move with fear. Over time, this can lead to weakness, stiffness, weight gain, poor balance, reduced endurance, and anxiety about movement. Physical therapy helps interrupt that cycle. By identifying safe movements, restoring strength, improving mobility, and teaching people how to manage symptoms, PT helps patients take control instead of feeling controlled by pain. For example, a person with knee arthritis may believe that pain means they should stop walking or exercising. In reality, the 2019 American College of Rheumatology and Arthritis Foundation guideline strongly recommends exercise for people with knee, hip, and hand osteoarthritis [American College of Rheumatology/Arthritis Foundation, 2019.]. That does not mean every person should do the same exercise. It means the right exercise, progressed properly, can reduce pain, improve strength, and make daily activity easier. A person with back pain may think bed rest is the answer, when prolonged rest often makes the problem worse. A person with shoulder pain may avoid reaching overhead, but the real issue may be weakness, stiffness, poor mechanics, or irritation that can improve with the right treatment plan.
Physical Therapy Focuses on Function
Another major benefit of physical therapy is that it focuses on function. Pain relief is important, but people usually want more than a lower pain number. They want to return to gardening, golfing, working, lifting, walking, exercising, playing with family, or simply getting through the day without fear. A good physical therapy plan is built around those goals. Treatment may include hands-on manual therapy, therapeutic exercise, balance training, posture and movement education, flexibility work, strengthening, pain-relief strategies, and a home program that empowers the patient outside the clinic.
The Power of Patient Education
Physical therapy also provides something that many quick-fix approaches do not: education. Patients deserve to understand what is happening in their body. They should know which movements are safe, which activities need to be modified temporarily, and how to rebuild capacity over time. When patients understand their condition, fear decreases. When fear decreases, movement improves. When movement improves, function improves. That is how quality of life begins to return.
The Right Care, at the Right Time
This does not mean physical therapy replaces physicians, imaging, injections, or surgery in every situation. There are times when those options are necessary and appropriate. The best healthcare is not “either-or.” It is the right care, at the right time, for the right person. However, for many common problems such as low back pain, neck pain, arthritis, tendonitis, shoulder pain, knee pain, balance issues, sports injuries, and general loss of mobility, physical therapy is often a smart place to start.
Consider Physical Therapy Before Surgery
The message is simple: before you assume you need an MRI, injection, medication, or surgery, ask whether physical therapy can help. In many cases, PT can reduce pain, improve strength, restore movement, improve balance, increase confidence, and help people return to the activities that make life meaningful.
At Mishock Physical Therapy, our goal is to help people move better, feel better, and live better. Pain may be common, but losing your independence, confidence, and quality of life should never be accepted as normal. If pain is affecting how you walk, work, sleep, exercise, or enjoy life, do not wait until it becomes a bigger problem. Before the MRI, before the injection, and before surgery, consider physical therapy. It may be the step that helps you avoid unnecessary care, reduce pain naturally, and get back to living your life.
We can help!
Visit our website to read more physical therapy related articles, learn more about our treatment philosophy, our physical therapy staff, and our 5 convenient locations in Gilbertsville (610-327-2600), Skippack (610-584-1400), Phoenixville (610-933-3371), Boyertown (610- 845-5000), Limerick (484-948-2800) at www.mishockpt.com or request your appointment by clicking here.
Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has also authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon or train2playsports.com.
