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I Have Back Pain Do I Need A Scan - Blog - Physio.co.uk - Leading Physiotherapy Provider in Liverpool and Manchester

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This is a question we are often presented within clinic.  

More importantly, it’s a question our patients often ask themselves and others, sometimes receiving some pretty scary answers!

For the purpose of this blog, I’ve taken low back pain as our example, as up to 90% of us will experience some form of back pain in our lifetime (don’t worry, the good news is that 90% of these will recover within 6-8 weeks).

When looking at back pain as a whole, more than 90% (there’s that 90% again) of cases can be put down to what we call ‘benign mechanical problems’.  In other words, there is nothing serious or scary happening in our back and there is plenty you can do to help it improve (this also is where physio can come in). Often this will require improvement to your muscular strength, mobility and general exercise levels.

Fewer than 5% of low back pain patients have a sinister explanation for their pain, such as inflammatory disease, infection, or malignancy. This is good to know, as one of the main driving forces behind our patients requesting a scan is fear of something serious causing their pain.

Mechanical back pain can be effectively assessed, treated and diagnosed by a physiotherapist and, in the majority of cases, scans of the spine are not too useful. In fact, they can often have the opposite effect and cause further worry and unnecessary concern.

Scans, such as an MRI, can identify what we call ‘incidental findings’- these being minor physiological changes in the back that are not contributing to or causing a patient’s pain or problems.  For example, if we take a large group of people in their 40’s who have NO BACK PAIN and perform an MRI, up to 70% will have signs of ‘disc degeneration’ and over 50% will have ‘disc bulges’… but remember, none of them had any back pain.

This increases to 85% and 70% respectively if the same scans are performed on 60 year olds (again with no pain).  

So what does this tell us?

Well, it indicates that there is a poor relationship between findings on scan and actual back pain.  It has led us to understand that these changes in the spine as we get older are ‘normal’, like our hair turning grey or wrinkles in our skin. It also makes us think twice about scans as they may cause further concern for patients through incidental findings (especially if these aren’t explained properly by the health professional!).

So when are scans useful?

There are two main reasons why we may look to a scan for help…

Firstly, if we suspect that a patient is one of the less than 5% of back pain suffers who may have a sinister cause for their pain.  

Doctors and physiotherapists are trained in gathering a comprehensive history and performing a physical assessment which will help them to rule out any sinister causes of back pain.  If one is suspected, then further investigations would therefore be appropriate in order to rule it in or out.

Secondly, on the rare occasion that we (and the patient) feel that there may be a surgical treatment option (for example prolonged, severe leg pain due a nerve compression in the back which has failed to resolve), it is useful for a surgeon to have a better idea of what would need to be performed and where.  Although, it is worth remembering that only about 10% of referrals to a spinal surgeon are appropriate for operative intervention.

SO in answer to the initial question: I have Back Pain. Do I Need a Scan?

90+% of the time . . . no, a scan of the back is not required and adds little to the overall picture painted by a thorough physiotherapy assessment.  If you are one of the 90% suffering from mechanical back pain, a scan may even add to your worries by pointing out things that were already there and are not the cause of your pain!  

If you have any concerns in regards to your back pain, then you should seek advice from a physiotherapist or doctor so that they are able to perform a full screen and help to put your mind at ease.  

If you’re looking for treatment in regards to your ongoing back pain and would like to know more about how physiotherapy can help, our team is here to help.

Rerences:

Indications for and results of outpatient computed tomography and magnetic resonance imaging in Ontario.You JJ, Purdy I, Rothwell DM, Przybysz R, Fang J, Laupacis A Can Assoc Radiol J. 2008 Jun; 59(3):135-43.

Potential triaging of referrals for lumbar spinal surgery consultation: a comparison of referral accuracy from pain specialists, findings from advanced imaging and a 3-item questionnaire.

Simon D, Coyle M, Dagenais S, O’Neil J, Wai EK

Can J Surg. 2009 Dec; 52(6):473-80.

Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain.

Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH

Arthritis Rheum. 2009 Oct; 60(10):3072-80.

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