Do I need an X-ray or Scan if I have Back Pain?
Do I need an X-ray or MRI?
Physiotherapists like myself are often asked by our patients if they need further investigations such as X-ray or MRI scan to help understand and treat their pain or decreased function. The simple answer is that further investigations are rarely indicated and can in some instances be counterproductive. How I hear you ask? Well firstly there is poor link between MRI/X-ray findings and what a person might be feeling. For example, findings such as disc prolapse, wear and tear or muscle wasting among others are commonly found in people without any pain and conversely those in great pain can have pristine MRI scans. MRI’s therefore should be reserved for when there are suspected red flag symptoms which may require urgent intervention.
Inconsequential structural findings such as disc issue on scan can influence how a person may live their life and make them feel vulnerable to future issues when in fact disc prolapse, wear and tear findings etc do not necessarily explain or predict pain and disability. If such things are found on scans I believe that the clinician has a duty to look at the whole picture rather than just the scan result as pain is only partly explained by biological findings. To further highlight this a study of 148 people in 2001 showed that on MRI:
91% had signs of disc degeneration (‘wear and tear’)
56% had disc height loss
64% showed at least one disc bulge
32% demonstrated at least one disc protrusion (‘slipped disc’)
38% reported at least one annular tear (tear in outer part of a disc)
The interesting and significant thing in this study was that the 148 people studied had NO BACK PAIN! It is therefore useful to think of these changes in the same way as we do wrinkles and grey hair rather than something abnormal to worry about. Therefore If you have been told that your pain is down to what was found on scan or X-ray I would advise you speak to a Physiotherapist who should be able to put things into context and to see what else maybe contributing to your pain.
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