If I had to put money on it then I would bet that you DO NOT! Very rarely is imaging, in any form (X-ray, CT or MRI), required in the diagnosis and management of back pain.
In fact research has shown that people with back pain who DO get MRI’s actually have prolonged disability and are more likely to undergo unnecessary surgery, compared to those who do not have imaging [1]. So getting a scan may actually do more harm than good!
Simply put, scans do not show the cause of pain. MRI scans show highly detailed images of our body’s and can indicate the presence of “degenerative changes” in the spine such as disc herniation's, disc degeneration and facet arthropathy.
But if you were to pick out 100 random people in their mid 40's with NO back pain and take an MRI of their spines you would find 68 of them have disc degeneration and 50 of them have disc bulges [2]. As we age these figures continue to increase, but interestingly the prevalence of back pain does not.
These "degenerative changes" should actually be called NORMAL AGE RELATED CHANGES as several studies have shown no association between “degenerative changes” and back pain [3]. These changes are simply part of the ageing process, the same as wrinkles and grey hair.
There are certainly times where imaging is required, but this should only be discussed after thorough questioning and assessment has been completed by a qualified health professional such as an osteopath, physiotherapist or GP.
Guidelines state that imaging should be avoided within the first 12 weeks of back pain unless there are “red flags” present (symptoms that indicate further investigation is required) [4]. If you are experiencing any of the following signs or symptoms associated with your back pain you should seek medical advice from a health professional immediately:
- Difficulty urinating or urinary incontinence
- Changes to bowel function, including faecal incontinence
- History of cancer or unexplained weight loss or weight gain
- Heavy trauma that initiated the pain, such as a car crash or fall from height
- Worsening pain not relieved by anything
- Weakness, numbness, or pins and needle sensations in your legs or pelvic region
Remember that the vast majority of back pain is self limiting, meaning it will resolve on its own within a few weeks. Try to stay active, avoid bed rest, and maintain a positive mindset, as these have all been shown to positively impact your recovery.
Your feedback is super valuable so if you have anything to add, any questions, or have a specific topic you think I should discuss, then drop a comment below and I'll reply as soon as possible!
If you would like any more information or are experiencing back pain and would like some advice, you can book an appointment at Forward Osteo online or call the clinic on 03 5215 1788.
Follow us on Facebook and Instagram @forwardosteo for more content!
Aidan Mill is the owner and principal osteopath at Forward Osteo
Osteopath Geelong West
References:
1. Webster, B. S., & Cifuentes, M. (2010). Relationship of Early Magnetic Resonance Imaging for Work-Related Acute Low Back Pain With Disability and Medical Utilization Outcomes. Journal of Occupational and Environmental Medicine, 52(9), 900–907. doi: 10.1097/jom.0b013e3181ef7e53
2. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
3. Rao, D., Scuderi, G., Scuderi, C., Grewal, R., & Sandhu, S. J. (2018). The Use of Imaging in Management of Patients with Low Back Pain. Journal of clinical imaging science, 8, 30. https://doi.org/10.4103/jcis.JCIS_16_18
4. Flynn, T. W., Smith, B., & Chou, R. (2011). Appropriate use of diagnostic imaging in low back pain: A reminder that unnecessary imaging may do as much harm as good. Journal of Orthopaedic and Sports Physical Therapy, 41(11), 838-846. https://doi.org/10.2519/jospt.2011.3618
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