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Do I need a scan for my back pain?

In short probably not, so here is some information to understand why.

 

Value vs risk

X-rays and CT scans are the first choice for scans as they cost significantly less then MRI scans and can be very effective at ruling out serious pathologies such as tumours. Both of these forms of imaging have high levels of radiation, therefore exposure should be limited to preserve health. MRI scans provided more detailed images with no radiation however these are very costly and are not always the best option of scan for the particular issue.

Is the image relevant to my pain?

What many people find difficult to understand is that structural changes do not always correlate with pain. Most changes that occur to our spine are a normal part of aging. Often if changes happen slowly, over a period of time we are unaware of them and we feel no pain from them.

The graph below shows the findings from a study looking at MRI scans of the lumbar spine (low back) of individuals aged between 20 and 80. All participants who were canned where pain free. The bars represent the percentage of people that had positive MRI results for the various physical changes listed.

You can see from this graph that as we age we are more likely to develop various physical changes in our spine. These are normal signs of aging, a bit like wrinkles on our skin. We could argue whether these actually are ‘abnormal’ findings. If 84% of 80 year olds have a disc bulge this seems more like a ‘normal’ finding for this age group.

So now that we know what is ‘normal’ to find on an MRI scan, we can be a bit more aware that the findings may not be the source of our pain but might be a red herring, that could have been there long before pain developed.

Graph showing percentage of people with 'abnormal' finding on MRI by age

When is a scan useful?

A scan is most useful to rule out serious pathologies such as fractures, tumours and infections. It can also be used to see if there is impingement or contact on structures such as nerves. Usually when pain is located only in the back with no referral pain elsewhere a scan will not be useful and will not change your treatment plan.

A scan is needed when a collection of symptoms indicate that there may be a need for additional treatments, or that exercise and physiotherapy along may not be effective. This would be if you have a collection of: back pain along with referred pain such as into your buttocks, groin or down your legs; if there is bilateral leg pain; if there is a cluster of neurological symptoms such as numbness, pins and needles and weakness in your legs; or if there are systemic symptoms such fever, night sweats, unexplained weight loss or constant pain. In many of these cases a scan will clear for serious pathologies and non-invasive treatment will still be effective.

It is only in rare occasions when invasive treatments such as injections or surgery are required.

If you still have some unanswered questions or want to talk to a physio about any specific concerns that you may have, please get in touch with the Flawless Physio team here.

Feel good. Move well. Be better!

 

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