In one of our previous blog posts we briefly discussed the tricky topic of imaging and whether there was a benefit from having a scan of the low back. So, in this blog post I thought we would take a slightly more in depth look at the pros and cons of imaging and try to address a common question that physiotherapists get asked: "Do I need a scan?"

Well I really wish this there was a straightforward answer to this question, as it is something that I as a physiotherapist get asked on a daily basis and despite the fact that it sounds like it should be straightforward to answer almost inevitably leads onto a long conversation with a patient about imaging and its pros and cons. Typically many patients with back or neck pain will be extremely anxious about wanting to get a scan or X-Ray done to find out what is going on and what is causing pain and for the vast majority of these patients imaging has no purpose and often will cause them greater anxiety when they do get the scan done! Okay, before things get too confusing I think it is best to break the concept of imaging down into manageable chunks:

1. What is the Purpose of a Scan?

Imaging in the form of X-Rays, Ultrasound Scans, MRIs and CTs has several purposes but primarily it is used to aid a diagnosis and give clinicians and patients information that they could not get from a clinical examination and history taking. They are specifically useful in ruling out sinister pathologies such as a tumour when the clinical examination suggests that there may be a risk of this and are useful when conservative management of a condition seems not to be working and it is looking likely that the patient may need to see a consultant.

A key point from above is that the information that a scan gives is only useful if it couldn't be gained from a clinical examination alone. So if after examining a patient's shoulder - everything points to a rotator cuff strain that is healing well and should resolve well with physiotherapy there would be no added information to be gained from a scan or imaging. However if on examination of the shoulder some of the symptoms from the patient gave the physiotherapist a cause to be worried about a sinister pathology such as lung cancer (this is rare) then imaging would be appropriate to rule this out. Imaging also serves a purpose when after a period of conservative treatment a patient is not improving or if upon examination it is apparent that the condition is unlikely to respond to physiotherapy. In this case the patient is likely to need some form of opinion from a consultant and imaging will be important in deciding upon the next best course of action. In this case the results of the scan will change treatment options.  

2. Will a Scan Show What is Wrong With Me?

Modern medicine and imaging has made huge advances over the last 30 years but despite this an image alone in the form of an X-Ray or MRI often will not accurately depict what is causing a patient's pain. Sometimes it will such as in the case of large break of the ankle - in this case an X-Ray should show exactly what is causing the patient's pain.

However in the case of low back or neck pain the reality is that a scan will often not show anything specific which can be extremely frustrating for patients. In the case of back pain there are many studies that have shown that it is pretty much impossible to predict from the results of a scan who will have back pain and furthermore things in the spine such as disc degeneration and herniations that it is assumed could cause pain are often present in the scans of those who have never had back pain!

Some patients (especially the elderly) will have a scan of the low back and it will show a huge amount of degeneration, arthritis, disc thinning and general wear and tear and will assume (and are often told by their GP) that their back is "knackered" whereas the truth is that many of these things will have been present for decades and in fact are just age normal results on an MRI.  

3. So, Do I Need a Scan?

Okay, so when should you be getting imaging done? Well as I have said above the answer is it depends!! In general if there is no suspicion of a sinister pathology and the clinical examination points very strongly to a particular diagnosis then there is likely to be little gained from having a scan. In fact results that may well be age normal findings such as "degeneration" may actually worsen the patient's prognosis due to causing them a large amount of worry and fear. However if there is a suspicion of a sinister pathology, if the patient is not responding to conservative treatment or if the results of the scan are likely to change treatment then the answer would be yes.

I hope that you have enjoyed reading this blog post. For anyone reading this blog who hasn't come across our site before: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 25 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk