Dear Editor

We read with great interest the recent study by Fawcett et al. [1], “The influence of spinal position on imaging findings: an observational study of thoracolumbar spine upright MRI in elite gymnasts”. We appreciate the author’s efforts to highlight the effects of repetitive stress movements of the back, even in the young population and new advancements in MRI to diagnose these. However, we wish to put our few queries and want to know the author’s input so that message from this study is presented with greater clarity.

  1. 1.

    Were any athletes’ groups following any core strengthening regime different than others, and what was the difference in findings if present [2]?

  2. 2.

    Potential disadvantages of positional MRI are cost, time, availability, inability to complete the test due to symptoms and inferior image quality (As positional MRI are usually done on less Tesla compared to supine MRI) [3]. Do you recommend any specific complaints for positional MRI, or are all three Positional MRIs required as standard in low back patients?

  3. 3.

    As suggested by a few studies, athletic activities in adolescent age could result in irreversible lumbar vertebra changes with or without symptoms [4]. Does positional MRI to be done in these groups routinely, even in the absence of symptoms, to introduce any preventive programmes or strengthening regimes to minimize these changes?

  4. 4.

    In symptomatic patients, should the position for MRI be so to reproduce the symptoms, which may help uncover MRI findings?