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