Imaging for back pain – is it always necessary ?

stock-photo-acute-pain-in-a-male-lower-back-monochrome-image-isolated-on-a-white-background-341735282Low back pain is very common. Most of us will experience some form of back pain in our lifetime.

So is it always necessary to have an imaging like Xray, CT or MRI to work out the cause of the back pain?

Here are some of the downsides associated with back imaging that should be considered:

  • Imaging will often reveal disc degenerative changes, and disc bulging, which can be viewed as normal age related changes in the spine and not related to pain and symptoms experienced by the patient.
  • Imaging can often make the individual, anxious and apprehensive about the pain and the findings on imaging.
  • imaging doesn’t necessarily improve outcomes. Often people’s back pain with the correct treatment and diagnosis have a good prognosis.
  • Imaging can expose the individual to unnecessary radiation especially CT scans.
  • Cost is also a consideration when deeming if imaging is necessary.
  • As mentioned before imaging often shows evidence of disc bulging and disc degeneration that may lead to unnecessary treatment procedures/surgery based on these results.

Medical imaging definitely has its place with certain back pain patients and can be deemed necessary. A physiotherapist can help to identify if the individual presents with “red flags” and requires imaging.

Red flags for back pain are:

  • Worsening nerve symptoms
  • Bowel or bladder dysfunction or numbness in the saddle region
  • Signs of a fracture (traumatic or history of osteoporosis)
  • Signs of inflammatory disease (night pain or morning stiffness)
  • Signs of infection (fever)
  • Signs of cancer (night pain, unexplained weight loss, unremitting pain)

In Touch Physiotherapy will assist in assessment and diagnosis of your back pain and refer on to an orthopaedic specialist and for relevant imaging if necessary.


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