What you should know about X-rays, MRIs and CTs

Our expert advises on how to best diagnose an aching back.

Are these scans helpful or harmful?

Back pain is a common condition that physiotherapists treat on a daily basis. One of the first questions commonly asked is whether imaging or further scans are required.

A range of factors influence whether your physiotherapist will refer you for further imaging. For most people experiencing back pain, medical imaging (such as X-rays, CT scans or MRIs) will not help with assessment or future treatment. There have been numerous studies and trials that have identified no advantage in routine imaging of low back pain and can actually cause potential harm and increase symptoms. 

Imaging regularly shows changes that may have occurred over time and may actually be irrelevant to current symptoms. Studies have shown that people who are pain free may have disc bulges and degeneration. In one study, MRIs were performed on subjects who did not experience low back pain, and 52 per cent of these pain-free subjects had at least one bulging disc or other significant imaging findings. In other similar studies, MRIs on individuals who had never experienced low back pain identified that 20 per cent of the participants under 60 per cent had a herniated or bulging disc. 

Conversely, there are cases of people experiencing extreme pain and symptoms yet no abnormality on medical imaging. In fact, recent research has shown that early imaging may actually increase the severity and duration of symptoms associated with low back pain.

This is not to suggest that bulging discs or other structural abnormalities cannot cause pain. However, it is important to consider that a lot of these ‘abnormalities’ present in a large proportion of the population. Remember, should you be experiencing low back pain, a thorough and comprehensive physical assessment is a great starting point to identify an appropriate treatment plan. 

As a physiotherapist, while imaging can play an important role in diagnosis, I will generally only recommend investigations for back pain if there is suspicion of an underlying medical or serious disease, such as cancer or infection. 

Jason Lee APAM
B. Physiotherapy
Malvern East Physiotherapy

Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.

Jason is happy to answer any questions you may have. Simply send an email to [email protected]



    To make a comment, please register or login
    19th Apr 2018
    What an absolute lot of bunkum.
    Physiotherapists can do more harm than good manipulating a damaged spine and any good physio knows that. Good grief - get rid of this article before someone ends up a paraplegic.
    19th Apr 2018
    Absolutely, YLC should get rid of this dangerous article asap before someone gets affected by this BAD advice.
    Physiotherapists are NOT doctors. If you have pain, go and see a GP first, who may check out various things, maybe get XRays, etc done, and then refer on to a Specialist for further analysis - whether by MRI or CT Scan, etc - let the REAL DOCTOR decide!
    The above scans would identify where the pain is likely to be coming from, based on which you (the patient) and the doctor can then decide on the appropriate action to take - maybe just precautions such as how to protect your back knowing WHERE / WHAT the problem is, or maybe even get physiotherapy.

    I have to mention a case I know of - a person who fell and hurt his back (broken bone) had physiotherapy which caused the broken fragment to poke a nerve and he ended up with a urine blockage problem requiring carrying a bag for the rest of his life!

    19th Apr 2018
    It's quite possible that a person can have severe back pain but the CT scans and MRI's will not reveal the cause. I have had continuous nerve pain in the upper spine, that also causes sensitive hearing and sensitivity to supermarket chill.

    This started in 2006, there was a lot of MRI's and CT scans but they were only guessing at which nerve bundle was causing the problem. An injection of painkiller into the suspected area of concern brought no relief.

    I have been on pain killers 24 hrs a day since 2006 and specialists don't see any value in revisiting the problem. Some believing that the problem could lie in the pain receptors in the brain although the pain is localized to the upper spine.
    19th Apr 2018
    I would say that chiropractors are even more dangerous than physiotherapists. They even call themselves doctor!
    20th Apr 2018
    Physios just keep telling you to book another appointment every time you see them. As for chiropractors I consider them quacks of the highest order. Would never go near one ever again.

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