Shall I get an X-ray, MRI, ultrasound, CT…… SCAN?
Don’t get me wrong, we do refer patients of ours for scans! However, this is not our go to response when someone present with an issue or pain.
Why?
Don’t you want to know exactly what’s wrong?
How will you otherwise definitively know the cause of someone’s pain?
Scans are great for certain conditions, they can be beneficial in ruling out more serious or sinister pathologies and if a fracture is suspected or there is potential for one to be present then we’re definitely pointing you in the direction of a hospital.
Also, if things just don’t quite add up then we will refer for a more thorough investigation and this is essential when it comes to numerous potential issues. We’ve had patients before who we’ve referred because something “didn’t look quite right” and we have been right to do so, managing to pick up signs of something serious.
However, getting a scan doesn’t provide the definitive answer everyone is after. Often people will present with the results of their scan and it is not the cause of their pain, sometimes not even close to where the pain is. If something does show up on a scan we are still unable to determine whether it is a cause of their issue or potentially a result of how they move. Often if we address areas that contribute to their pain, it will resolve. EVEN IF THE UNDERLYING CONDITION IS STILL PRESENT.
More importantly, the body does heal! That disc issue in an individual’s lower back will get better. Don’t reside yourself to the fact that your pain will now last forever because of the “damaged disc”. Maybe that disc became damaged because of how you moved in the first place. We need to think about why your back was becoming overloaded and this structure was unable to cope. If this is addressed and managed, the disc issue can resolve, and we can make you more robust to deal with that potential overload when it comes.
So, let’s talk about lower back pain.
In one study, 37% of 20 year olds assessed by MRI had disc degeneration, 30% had disc bulges and 29% had disc protrusions. This increased to 96% (disc degeneration), 84% (disc bulges) and 43% (disc protrusions) in 80 year olds (Brinjikji et al., 2014). Most importantly, THIS STUDY WAS COMPLETED ON 3110 ASYMPTOMATIC INDIVIDUALS! That is, PEOPLE WHO WEREN’T IN ANY PAIN!
Can we really relate your pain to your scan?
Similar results have been found for neck MRI, Knee MRI (Guermazi et al., 2012) and shoulder MRI (Del Grande et al., 2016) in PEOPLE WITH NO PAIN. The question by Tran et al., (2018), “What imaging detected pathologies are associated with shoulder symptoms?” presented the following conclusion – “Shoulder imaging is increasingly used for assessment of shoulder pain. Despite this rise, the relationship of imaging with symptoms and its role in informing management remain unknown”
Even more important, could you scan reduce the long term outcome for your pain or even make your condition worse?
Once people have a diagnosis, they latch on to that one thing, for a very long time! Past the point where what was found on that scan has resolved. In their head they are damaged! This doesn’t help when it comes to pain.
Pain is very complex and can be related to a number of factors, not just what is going on anatomically or physiologically. It often comes down to PAIN and THE BRAIN. That’s a story for another day.
Again, thinking about lower back pain, the most common thing we see. Patients with back pain who are referred for a scan may have worse outcomes. Those with acute lower back pain if offered a SCAN have a reduced chance of recovery and their pain is more likely to become a chronic issue (Stevans et al., 2021). There are of course other factors involved but opting for a scan in those initial phases may influence someone’s psychological view of their injury before really tackling the cause of the issue.
As therapists we can do a lot to diagnose and understand the true cause of your pain. We are constantly making an informed decision about the best action to take for your condition. You may however have noticed that we don’t always provide you with a diagnosis. What it often comes down to is do you really need to know what the name of the issue is or just that it can be resolved, these are some contributing factors to your pain and this is what we will do about it.
I’m not saying don’t get a scan but ensure you’re doing it for the right reasons and always take the findings with a pinch of salt. There could be something that shows up on the scan that is not the cause of your pain OR nothing shows up and you’re still in agony. It doesn’t mean it’s wrong!
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