By Alex Fielding Physiotherapist/Chiropractor
X-rays, CTs and MRIs and other forms of imaging for low back pain are the most unnecessarily ordered scans in Australia. In fact both the Royal Australian and New Zealand College of Radiologists (RANZCR) and Australian Physiotherapy Association (APA) have both come out and said:
“Don’t perform imaging for patients with non-specific acute low back pain and no indicators of a serious cause of back pain”
The most simple and honest answer for this is that overwhelmingly imaging for low back pain doesn’t help you get better. For example if you are say, 40 years old, have no back pain at all and we took an MRI of your lumbar spine; what do you think we would see? Well, there’s a 68% chance we will see some disc degeneration and a 50% chance you would have a disc bulge and this remember is without having any pain at all!
However with a thorough history, a good understanding of what makes your back better and worse followed up with a clinically relevant physical exam, your team will be able to tell you a lot more than a scan alone.
So when is imaging the way to go?
There are certainly times when imaging for low back pain is important but they are few and far between. Some examples are
1. Your history or examination suggests that something serious is going on. For example, a previous history of cancer in combination with low back pain that doesn’t change with movement could be an indication that imaging would be appropriate
2. You have a neurological deficit related to your low back that is getting worse. For example progressive numbness and weakness into your leg.
3. It’s been 6 weeks, you’ve been diligent with treatment and you are not getting better.