X-Rays, CTs and MRIs and other forms of imaging for low back pain are the most unnecessarily ordered scans in Australia. In fact both the Royal Australian and New Zealand College of Radiologists (RANZCR) and Australian Physiotherapy Association (APA) have both come out and said:
“Don’t perform imaging for patients with non specific acute low back pain and no indicators of a serious cause of back pain”
The most simple and honest answer for this is that overwhelmingly imaging for low back pain doesn’t help you get better but it does expose you to extra radiation that you really don’t need to be exposed to. Furthermore for scans like an MRI that doesn’t expose you to radiation, most likely all the things you see on the scan are totally irrelevant anyway. For example if you are say, 40 years old, have no back pain at all and we took an MRI of your lumbar spine; what do you think we would see? Well, there’s a 68% chance we will see some disc degeneration and a 50% chance you would have a disc bulge and this remember is without having any pain at all! We’ve talked these findings previously here. So with that in mind if it’s 50/50 that your disc injury is actually causing you any pain at all, there isn’t really much point in getting the scan in the first place!
Simply put if I give you a picture of the Sydney Harbour Bridge, you won’t be able to tell me where it rusts. The same goes with your spine. However with a thorough history, a good understanding of what makes your back better and worse followed up with a clinically relevant physical exam, I’ll be able to tell you a hell of a lot more than a scan ever will. I can say this with certainty because the science and research that is out there backs this up.
So when is imaging the way to go?
There are certainly times when imaging for low back pain is important but they are few and far between. It is commonly accepted that there are only three situations where it could be a good idea.
- Your history or examination suggests that something serious is going on. For example a previous history of cancer in combination with low back pain that doesn’t change with movement could be an indication that imaging would be appropriate
- You have a neurological deficit related to your low back that is getting worse. For example progressive numbness and weakness into your leg.
- It’s been 6 weeks, you’ve been diligent with treatment and you are not getting better.
Out side of these situations, you should really be asking your health professional whether the scan is necessary.
For more recommendations about what treatments and tests are not necessary Choosing Wisely is an excellent resource and a highly recommend you take a look.
Because your health matters.