TO SCAN OR NOT TO SCAN?
Low back pain (LBP) affects two-thirds of the population at some point in their lives, and is the leading cause of activity limitation and work absence throughout much of the world. Low back pain can be acute, subacute or chronic. Although several risk factors have been identified such as occupational posture, depressive moods, obesity, body height or age, the causes of the onset of low back pain remain obscure and diagnosis difficult to make.
I’ve had a scan…
Often patient’s will come and visit us having had episodic back pain year after year, gradually getting worse each time so they are sent for a scan. After this scan patients find themselves hearing and using terms like; ‘disc bulge’, ‘degenerative spine’, ‘arthritis’, ‘slipped disc’ amongst many other fairly terrifying terminologies, which are enough to make one never want to move again for risk of the spine imploding!
Interestingly the table below shows percentages of spinal pathologies found in 3000 people. All of these people DO NOT HAVE BACK PAIN! So this proves that you can have so called pathology in the absence of pain.
Often, having a visual in mind and relating pain to that image gives the perception that avoiding activity is good and protective of the spine. In fact, this activity avoidance only compounds the problems that existed in the first place and lead to further deconditioning and dysfunction. With the right input, the dysfunction can be addressed, and treatment progressed to facilitate recovery by learning, adapting, strengthening and responding to your body in a positive way.
Some research even suggests that MRI scans provide no benefit and could result in worse outcomes (Webster et al., 2013).
Also, reports produced by different radiologists for scans on the same patient vary greatly, impacting on; diagnosis, choice of treatment and clinical outcome (Herzog, 2017).
‘But how do you know what is wrong without a scan to tell you?’
The evidence above is clear, scans only tell a clinician so much. The key to improving your low back pain is to see a health professional who will look at a wide variety of factors to help identify the cause of the issue. These should include; how and when the pain started, how it behaves throughout the day, the type of pain, your past medical history, physical test findings. Putting as much ‘evidence’ together from a guided conversation at an Initial Appointment is key to finding the answer to managing your back pain. Explaining these findings and importantly, how each of these relates to the treatment given is key on starting the road to recovery.
- Scans only form a part of an assessment into a patient’s low back pain
- Scans can vary depending on the interpretation of the images
- Scan findings often do not equate to the cause of your pain e.g. 37% of 20-something year olds have disk degeneration with no symptoms and 60% of 50-year olds have disk bulges with no symptoms
- Scans should only be considered for people with low back pain with or without sciatica only if the result is likely to change management
- It’s never too late to seek help; education, understanding and graded exercises are proven to be effective in most cases
Don’t let back pain affect your life – let us help you gain control over your it and drive you back into an active lifestyle!