Are you experiencing back pain? Have you recently gotten a scan? Has your doctor had a look at it and said “wow”. Did you hear that you have “bulging discs”, “herniated discs” “narrowing of the spinal canal”?
Quite often there is a misconception that imaging findings can strongly reflect back pain. Today’s topic will focus on imaging findings, how much it REALLY correlates with back pain and how imaging will affect physiotherapy treatment.
What does the research say?
For patients with acute lower back pain, there were no changes in outcome for pain, function and quality of life when comparing between those who got scans and those who had no no scans
A study performed in ASYMPTOMATIC individuals over the age of 60 years found that
36% had herniated disc
21% had spinal narrowing
90% had degenerative or bulging disc
MRIs were performed in 200 asymptomatic individuals at the start of the study and these people were followed for 5 years. Anyone who had an episode of back pain had another scan. Of those who developed clinically serious back pain, 84% had no changes on their imaging findings. Interestingly enough, on the first scan they found that:
50% had disc protrusions
30% annular fissures (degenerative changes to the outer part of the vertebral disc)
22% had nerve root irritation
This means that 90% of the individuals had something “abnormal” on their back scans but were ASYMPTOMATIC!!
over 90% of individuals had imaging findings without any significant low back symptoms, indicating that the association between such findings and symptoms is tenuous
What is the problem with getting unnecessary scans?
Inappropriate use of imaging is associated with a 2-3 x increase in unnecessary surgery with no improved outcomes
Exposure to radiation from some types of investigations may lead to increased risk of cancer
Fear and anxiety – suddenly being told you have problems with your back can elicit symptoms of lower back pain.
When is a scan warranted?
The presence of severe or progressive neurological involvement
Clinician suspicion of a serious condition such as:
Cancer
Fractures
Spinal infections
Cauda equina involvement (the bottom end of your spinal cord)
Will imaging change my physiotherapy treatment?
Where there is no serious underlying condition, which is the case for most people, physiotherapy management will be pretty much the same. A program of education, manual therapy and exercises tailored to your specific presentation
If you would like to learn more about your back pain – we have a number of great articles:
Whether you have just felt a niggle in your lower back this morning from bending over to tie your shoe lace, or you have been experiencing lower back pain for years with no relief, our physios at The Healthy Body Company will be able to assist you in achieving an accurate diagnosis and guide you onto the right path for treatment.
Verdict:
The majority of patients with low back pain do not need imaging.
Reference
Flynn, T, Smith, B, Chou, R, Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good J Orthop Sports Phys Ther 2011;41(11):838–846, Epub 3 June 2011. doi:10.2519/jospt.2011.3618
