In this day and age with easy access to Dr Google and a never ending stream of information about everything health related a question we’re often asked is ‘do you think I should have a scan?’. The simple answer is ‘not always’!
‘Scans’ in this context refer to medical imaging, things like X-rays, CT scans, MRIs and diagnostic ultrasound. These procedures are used to determine the state of structures inside our bodies such as joints, bones, ligaments, tendons and muscles. But is imaging the best option when it comes to treating shoulder, knee, hip or back pain? There is plenty of evidence from research to support the ‘no scan’ approach – at least initially. Some of these reasons include
Radiation: A CT scan of your spine can deliver the equivalent of up to 2 years worth of the radiation dose we receive from natural, everyday sources, a plain joint X-ray can deliver up to 6 months worth of radiation in one hit.
Cost: An MRI scan can cost between $300 and $500 dollars or more, often not covered by private health insurance.
Resources are limited so the time it takes to scan for low back pain or joint pain with no clinical justification ties up equipment and resources from other more urgent conditions, also unnecessary imaging that does have a Medicare rebate is just another thing eating into our already overstretched health budget!
Unnecessary Interventions: Medical imaging shows incredible detail, often of specific structures, people may then undergo unnecessary interventions, even surgery, for conditions which are really just normal age related changes, positional joint changes due to posture or temporary muscle tightness or injuries which will heal in time given the right management.
Patient Concern: Many of the ‘scary’ findings on the radiology report are normal changes that occur in our bodies as we age. Many have been there for ages and are not the cause of your current pain. These reports are often ‘interpreted’ in a way that causes anxiety and concern for the patient. There is strong evidence that non-clinical descriptions such as ‘bone-on-bone’, ‘wear and tear’, ‘collapsed discs’, ‘torn tendons’ can have a negative and detrimental effect on the time it takes to recover. Did you know that up to 30% of 20 year olds and 80% of 50 year olds with NO back pain will have changes on CT or MRI reporting a ‘disc bulge’!! (2014 study : American Journal of Neuroradiology).
Outcome: In many cases a scan will not change your treatment, management or outcome, but WILL cost you time and money!
So how will you know what’s causing my pain?
Physiotherapists are experts at examination. This involves a series of questions to obtain a detailed history, including mechanism of injury, distribution of pain, neurological symptoms, what aggravates and eases your pain, previous history, medical and health issues which might be contributing to the presenting condition – just to name a few!
We then take you through a series of tests and movements specific to the presenting condition. This helps us determine the probable location and cause of your pain and also helps us formulate a treatment plan and recovery timeline.
When DO we need to refer for a scan?
There are certain things that will automatically signal the need for medical imaging and referral to a Doctor. Some of these for back pain include
Complex neurological deficits – weakness, numbness, changes in bladder and bowel habits or control.
Unremitting, severe pain
Suspected fracture or other sinister pathologies
So trust in the clinical assessment and expertise of your physiotherapist to determine the best course of action.
Remember – although your pain might be extremely nasty and disabling, level of pain doesn’t always correlate with level of damage.