Recently we have seen several patients who have had X-Rays / MRI’s for back pain and have come to the clinic feeling worried by the findings. So how useful is the information really?

Do you need an X-RAY or MRI?

If you’ve been suffering from back pain it seems reasonable to assume that a good image of your back will show what’s wrong but usually this is not the case. In fact imaging can cause more problems than it solves.

Here is what the evidence tells us….

 

-Imaging should not be used in ‘non-specific back pain’.

X-rays and MRIs are a wonderful tool, but they are not recommended unless the intention is to rule out infection, fractures and cancer or in cases of severe neurological involvement. Most back pain cases do not fall into this category.

-X-rays and MRI’s cannot reliably diagnose back pain!

Your tests may show degenerative changes, spinal stenosis, disc bulges etc. but these abnormal results are commonly found in healthy people without back pain too!

There are lots of studies showing that there is virtually no correlation between imaging findings and the pain you are experiencing. The table below shows the findings in asymptomatic patients. Amazingly 37% of  20 somethings will have signs of disc degeneration and by our 40’s nearly 70% of us will be affected.

image findings in asymptomatic individuals

-They can make you feel worse!

Words like ‘degenerative disease’ and ‘bulging disc’ can be frightening to read. But we know from the point above that these changes are found just as commonly in people with no symptoms at all. The fear associated with these diagnoses can lead to pain avoidance.., giving up sports and daily activities to lead a more sedentary life. Our bodies thrive on being active and this fear avoidance pattern can create a negative spiral of increasing weakness and worsening pain.

-They can confuse the diagnosis.

Seemingly obvious problems revealed by scans, like slipped discs, are blamed for your symptoms. The evidence isn’t there to support this though, and you can end up having potentially unnecessary treatments (like injections and surgery) for changes that would have been just as likely to resolve by themselves.

 

The Osteopaths at the Plympton Osteopathic Clinic are trained to diagnose the source of your back pain and will only recommend MRI and X-Ray imaging if they need to rule out a more serious underlying medical condition.

Do you need help with your back pain…Or have you received a worrying diagnosis after X-ray or MRI which you would like to discuss?

We would love to help. Please get in touch!

 

FURTHER READING

Diagnostic imaging for low back pain… https://www.ncbi.nlm.nih.gov/pubmed/21282698?tool=bestpractice.bmj.com

Correlation of Pain and Disability with MRI findings… https://www.ijmhr.org/ijpr_articles_vol2_2/IJPR-2014-608.pdf

Iatrogenic Consequences of Early Magnetic Resonance Imaging… https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235393/

Diagnosis and Treatment of Low Back Pain… http://annals.org/aim/article/736814/diagnosis-treatment-low-back-pain-joint-clinical-practice-guideline-from

Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations… https://www.ncbi.nlm.nih.gov/pmc/articles/PMC446479

MRI and X-Ray Often Worse than Useless for Back Pain… https://www.painscience.com/articles/mri-and-x-ray-almost-useless-for-back-pain.php