When should I get a scan of my back?

I spend a lot of my time with clients in the clinic dealing with acute bouts of lower back pain. One common question that seems to be on everyone’s mind is:

Do I need a scan?

Well, that depends, because scans can be helpful, but they also have the potential to be harmful.

Often, I’ll have a new client come to my clinic with X-Ray results, or a CT and occasionally an MRI report. There is usually a heap of medical jargon (as it is a medical document) listed on the report, some of which may be relevant, but mostly we will see very NORMAL, age-related changes. The problem is, when someone reads these reports, they will see things listed like:

·       Degenerative change

·       Disc bulge

·       Annular tear

·       Facet arthropathy

·       Osteophytes

Our natural assumption is that because of this myriad of “problems” listed, we can attribute your pain to them, but pain is far more complex than this. It is extremely common to find the changes such that I listed above on very healthy and importantly, pain-free spines.

For example, a very large study investigating the lumbar spines (lower back) of 3,110 people by Brinjikji et al in 2015 found degenerative disc changes in 37% of 20 year olds and 96% of 80 year olds. Importantly, NONE of these study participants had any symptoms at all.

That’s right! Despite the fact that a large percentage of these people displayed degenerative changes on their scans, none of the 3,110 people had pain.

If that’s not enough proof for you, another large study by Nakashima et al (2015) investigated the cervical spines (neck) of 1,211 people between the ages of 20-70 years old. They found a bulging disc (“the horror!”) in 87% of these people. But, yet again, NONE of these people had any pain or symptoms.

So what does this mean?

It means that when we are inappropriately referred for a scan, sometimes the findings can cause us to worry, become fearful, reduce our physical activity, spend more money unnecessarily on medical treatments (like massage, manipulations, braces, injections, surgeries…) and take more medications.

In other words, scans can cause MORE pain and inhibit our recovery, often causing long term problems.

“Yes, that’s all well and good but my back pain is reeeeaaaalllly bad.”

That’s ok, did you know that pain is very complex, and can be increased by thoughts, emotions and behaviours. So if you are worrying about the long words on an MRI report, this has the potential to increase your pain.

So when do you actually need a scan?

Well, in the case of acute back pain, you should always see a health professional qualified in assessing and diagnosing these sorts of issues. Often, we will ask you a range of questions like:

1.       How did you hurt your back? Was there any specific mechanism?

2.       How long has the pain been present for?

3.       Do you have any cancer history?

4.       Do you have any numbness or pins and needles in your inner thigh/groin region?

5.       Have you noticed any loss in strength in one or both legs?

6.       Have you had any problems with your sleep? Like night sweats or pain that won’t change?

What we are trying to identify is the presence of a red flag – a sign that there may potentially be a serious underlying condition that needs to be ruled out, with an investigation like a scan or blood test. These sorts of serious conditions may need specific medical interventions if present, but remember, they are EXTREMELY RARE.

If there are no red flags present, or if we deem it appropriate to investigate with a scan or test, and rule out anything serious, it means your back pain can be managed with physiotherapy via modes such as education, manual therapies, and exercise.

In summary, management of lower back pain is complex, and requires you to feel confident in yourself physically. Unnecessary scans don’t empower you and rarely provide any additional confidence or feelings of safety. So if you are experiencing back pain and would like to have it assessed, or if you feel that your current therapist/clinician is scaring you with medical jargon or constantly restricting your daily activities or exercise, give me a call, or book an appointment through the button at the top right of the page.

Mick McGovern