Imaging, such as X-ray, MRI and CTs can provide valuable information for diagnosing damage to soft tissue and bone. However, there are many reasons why imaging may not be the first step we take in managing your pain.
If you aren’t sent for imaging, we have considered a number of factors for your individual situation before making this decision. If you are concerned as to why, then just ask!
Most Importantly: Will it change treatment?
As physiotherapists, we treat the symptoms you present with and how you are moving, not just the diagnosis. In fact, the treatment for two people with the exact same diagnosis may be very different as we all compensate for pain in different ways. Therefore, if the exact size and location of damage or a tear won’t change your personalised treatment plan, you don’t require imaging.
Some conditions do need imaging before treatment. We are trained to look for symptoms or signs that indicate these may be present.
We consider all the factors below and think ‘is imaging really required?’
Irrelevance of Findings
Imaging often shows ‘degenerative changes’, which are a normal process of ageing and do not relate to the sensation of pain. Many imaging studies have shown a high presence of disc bulges and labral tears in people with no pain or symptoms!
Only 5% of all lower back pain is associated with a serious underlying pathology that requires diagnostic imaging and specific treatment. Consequently, 95% of people with low back pain do not require imaging.
Therefore, with certain conditions; it is likely that findings on your scans are coincidental, have been there for a long time and are not the cause of pain.
Anxiety and Poorer Outcomes
Knowing about the presence of ‘degenerative changes’ has been shown to increase anxiety and decrease the expectation of your ability to get better. It results in the patient worrying about the ‘damage’ and the potential to harm themselves further. This is way of thinking is harmful and results in poorer outcomes!
Imaging may lead to a misdiagnosis
Using the lower back as an example again, if a disc bulge is found, it could be associated with your pain. However, many factors affect back pain and the cause could be something entirely different, such as changes in pelvic joint movement or muscle recruitment patterns. Unlike a disc bulge, these are not visible on imaging, but can be found with a thorough physiotherapy assessment and be treated accordingly.
Imaging is Expensive
A patient will pay $100-500 per MRI scan. Imaging is expensive not only to you as a patient, but for the healthcare system as a whole. If it’s not required, we don’t want to waste valuable resources.
X-rays and CT scans send radiation waves through the body. While the doses for medical imaging are relatively low, radiation is harmful for the body and risks increase with repeated exposure. Studies have shown an increased risk of cancer with repeated low doses of radiation. This is especially a concern for children, pregnant women and those of reproductive ages.
Correct Rehabilitation has Good Outcomes!
Imaging is often used to look further into an injury that is not responding to physiotherapy and may require more invasive treatments, such as surgery or an injection. Surgeons often recommend 3-6 months of physiotherapy before considering operating. They understand that surgery should be the LAST option. Many injuries can be rehabilitated successfully with physiotherapy and exercise, allowing us to return to the sports and activities we enjoy!
Physiotherapy can either postpone or avoid surgery entirely, which is important, as all surgeries carry risks. If surgery is eventually required, then the treatment and exercise completed isn’t a waste of time as it significantly improves post-operative outcomes.
Only after all these factors are considered will we decide if it is appropriate to refer you for imaging. As physiotherapists we can refer you for imaging and have direct contact with providers to ensure you get the correct imaging and results are passed onto you as soon as possible.
If you are concerned about or need advice on any of the above please do not hesitate to call us to book an appointment on 9970 7982, or alternatively book online.
Boden, S.D. et. Al. 1990. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic sybjects: a prospective investigation. J Bone Joint Surgery, vol. 72, pp. 403-8.
Jensen, M.C. 1994. Magnetic Resonance imaging of lumbar spine in people without back pain. The New England Journal of Medicine, vol. 331, iss. 2, pp. 69-73.
Lin, E. C. 2010. Radiation Risk from Medical Imaging. Mayo Clin Proc, vol. 85, iss. 12, pp. 1142-46.
Wassenaar, M. et. al. 2012. Magnetic Resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review. European Spine Journal, vol. 21, iss. 2, pp. 220-227.