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Do I need a scan | lower back pain

One of the most common questions I get asked when treating patients with lower back pain is, “do I need a scan?”. Lower back pain is extremely common and can be concerning, but the great news is that less than 1% of lower back pain and spinal conditions are due to a serious pathology and therefore can be managed without the need for imaging.

Lower back pain

It is estimated that around 1/3 of UK adults will experience lower back pain – anything from mild discomfort to more severe presentation such as sciatica or a slipped disc. Lower back pain makes up 1 in 15 of all GP consultations and is a significant cause of disability. If you have experienced lower back pain in the past, you will be acutely aware of how disabling this can be. If you are currently experiencing lower back pain, do check our recent blog on lower back pain and some simple exercises to get your recovery started.

As common as this condition can be, the great news is that only 1% of back pain is due to a serious spinal condition so you can be confident that you will get better.

MRI scans and imaging

There has been an explosion in the technology available for diagnostic imaging in recent years which, in the hands of an experienced clinician, can provide diagnostic accuracy and more importantly indicate the best treatments to ensure your recovery. Some clinics, such as here at The Physios, can offer in-house ultrasound scanning to help diagnose soft tissue conditions, for example a rotator tear or a tendon injury.

Xrays are the ideal choice for conditions affecting the bones, such as, knee and hip osteoarthritis or detecting a broken bone.

Gold standard imaging for the lower back to accurately diagnose conditions such as nerve root compression (which can cause referred pain and sciatica) or a prolapsed (slipped) disc is MRI. Magnetic Resonance Imaging uses strong magnetic fields and radio waves to produce extremely detailed images of almost any part of the body. MRI’s are also very safe with out the need for ionising radiation such as Xray.

So do I need a scan for my lower back pain?

As with all musculoskeletal conditions, diagnosis starts with a detailed discussion and clinical examination. From this point we can be pretty sure what’s wrong and will commence you on a treatment programme tailored to your needs and specific goals for recovery. For most lower back pain, imaging is rarely indicated as we would expect to see a sustained improvement with our treatments within a few weeks. There are certain conditions (slipped disc, sciatica, etc) where the recovery can take a little longer and the path to recovery a little bumpier, be we are confident that we can help.

If we suspect a serious spinal pathology we will initiate an urgent referral for a MRI scan during your consultation.

Do I need a scan – need to know or nice to know?

We will have a pretty clear idea of what is wrong following your clinical assessment. Better still, given our experience and post graduate education, we are confident that our treatments can help. If we take the example of a slipped disc, research shows that 66% of disc herniations recover without the need for invasive procedures or surgery. Furthermore in the case of knee osteoarthritis, there is often a mismatch between radiographic (X-ray findings) and knee pain.

I am a late 30’s, overweight (as per BMI) male who has played field hockey since I was 8. In field hockey, you run in a semi-squat/lumbar flexed position. The sport also involves twisting and turning on a synthetic pitch. I occasionally experience a little back ache and more occasionally experience some medial (inside) knee pain. However, I am fit and well and an occasional twinge in my back or knee doesn’t limit my lifestyle. With exception of some conditioning exercises, I don’t require any medical help such as physiotherapy. If I were to have an Xray of my knee, I am pretty sure that it would indicate some degenerative changes and an MRI of my lower back would almost certainly indicate disc bulges and joint degeneration.

Johnny Cassidy, clinical director

Now would such imaging be helpful? In my case definitely not! I don’t need or want to know about the early signs of osteoarthritis in my knee or that a lumbar disc is getting closer to the nerve root. With some lower back conditions, sometimes it would be nice to confirm our diagnosis but a scan will not change the course of treatment making it difficult to justify a costly examination procedure.

So leave it up to us – if you need a scan we will discuss this with you and initiate a referral via your GP. If you are developing any concerning symptoms or treatment is not quite going to plan, the need for imaging or further investigations will be at the forefront of our clinical reasoning. You are in safe hands!
View more articles from Johnny Cassidy

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