It is estimated that 70 - 90% of Australians will experience back pain at some point in their life*. Back pain can be debilitating and is very confusing and distressing for sufferers when it continues for days and weeks at a time. Patients are often referred by medical professionals to have imaging such as X-Rays, CT Scans or MRIs, sometimes being ordered “just to be sure”, but is this helping or hindering us?
It is very important to note only 5-10% of scans have findings that are linked to the pain you feel.
A study recently published in The Spine Journal, had researchers send a 63-year-old woman with lower back pain and a specific set of other symptoms to MRI appointments with ten different radiologists. The radiologists collectively made 49 distinct findings. Zero, however, made it into all ten diagnoses, and only one was reported in nine out of the ten.
Findings on scans are highly common in people of all ages with or without back pain, for 90% of us the findings are not relevant to our pain. Consider the results of a major 2015 review by Brinjikji et al: signs of degeneration are present in very high percentages of healthy people with no problem at all. “Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”
This doesn’t mean you don’t have pain or “the pain is in your head”. The muscle tissue and joints for example may be very sensitive but the way they look on a scan is not always related to the pain.
There is very strong evidence that the findings on scans do not predict your outcome. However, information you are given can have a negative effect. Words or phrases such as ‘degeneration’, ‘disc bulge’, ‘protrusion’, ‘wear and tear’, ‘slipped’, ‘instability’ can cause further worry, distress and make you want to stop doing the things you enjoy doing. Very often the scan findings are the same even after your pain resolves. This is often the case with a ‘disc bulge or protrusion’ a person’s back pain resolves and they have returned to normal life but the ‘bulge’ is still evident on the scan – indicating no link with the pain!
An experienced health practitioner, such as a physiotherapist, through a skilled examination can work out if you require a scan or further testing for your specific problem.
If you are having trouble making sense of your scan findings, information provided to you or would like a second opinion, seeking the help of a physiotherapist can provide clear and easy to understand information to allow you to move forward. Physiotherapists are highly experienced at assessing and interpreting this information.
If you have any questions please feel free to contact us at Kimberley Physiotherapy.
*Figures from Australian Institute of Health and Welfare