Whether or not to get a scan for lower back pain (LBP) is a common question we get asked in the clinic. LBP is a common occurrence in our population and can be a cause of frustration and discomfort if it perseveres.
The good news, however, is that the majority of LBP cases (>90%) are mechanical in nature, which means that the reason for your pain will be down to faulty movement patterns, lack of movement, reduced strength or reduced exercise levels. This is good because it means nothing “serious” is causing your back pain and physiotherapy can help to relieve your LBP.
So do we need to scan your back to ensure you are not in the 5-10% of cases?
The answer will still most likely be no. Doctors and physiotherapists are trained to ask specific questions and carry out assessments that will guide us to rule out more sinister diagnosis’ such as inflammatory back pain, infection or malignancy (cancer). In addition, assessments will also rule out nerve root compressions that may require surgical intervention.
But what about disc injuries? Or joint arthritis?
Sometimes MRI’s can be unhelpful in that they show things that are not necessarily useful. Research¹ has shown that disc degeneration in asymptomatic individuals (i.e. people with NO pain) ranges from 37% in 20-year-old individuals to 96% in 80-year-olds. In addition 30% of 20 year-olds have disc bulges and up to 84% of 80-year-olds also have them. This shows us that some MRI findings aren’t necessarily the cause of your symptoms and there is very poor correlation to actual back pain.
So are scans ever helpful?
Based on the above information we can therefore conclude that MRI scans for LBP can be considered if we are looking for a more serious or sinister condition that would require further medical intervention. MRI's can also be done if the person is an adequate surgical candidate (e.g. progressive neurological symptoms and nerve compression failing to resolve) and they have seen a specialist surgeon that has deemed surgery appropriate.
¹ Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. (2015) Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. Review.
Please contact us on 9301 4711 if you would like to book an appointment or find out more information.
Laura Cruz - http://www.joondalupphysiotherapy.com.au