By Tully Hogan-West
Physiotherapist at Life Ready Physio Midland

If you have ever experienced back pain in the past, either an acute episode or a long term issue, the question, ‘do I need a scan?‘ has probably crossed your mind.

The answer: PROBABLY NOT.

Contrary to popular belief, scans of the lower back, be they X-ray or MRI, have been shown to have little to no correlation to an acute lower back pain.

A study by Matsumoto (1) in 2013 found 78% of asymptomatic volunteers with an average age of 48 had some sort of disc derangement on imaging. This study suggests that disc bulges, protrusions and narrowing of the disc space can be a normal, age-related finding.

The current recommendations from CHOOSING WISELY (2) for scans of the lower back are to trial a period of treatment, combining hands on therapy and exercise over the course of a month or so to assess the progress of your back pain.

If you are experiencing no change, progressive neurological change or a worsening of your symptoms, then your medical professional can guide you to what scan is most appropriate.

The majority of people who get a scan don’t need one in the acute setting and of those people, a large number of them will have a finding that is NOT relevant to their pain.

When should you wait to get a scan?

• If you have woken up with a sore back
• If you have developed a pain that comes on with movement and eases with rest
• If you have no history of trauma
• If you have mild numbness or tingles down the leg (with no other neurological sign)

When do you ACTUALLY need a scan? (2)
In an acute setting:

• If you are experiencing signs of spinal cord compression
• If you have numbness and issues related to toileting
• Progressive neurological deficit at multiple levels of the body
• Weakness and unco-ordination of the arms and legs
• A history of cancer and an acute onset of back pain (especially if it is not related to movement)
• A history of significant trauma to the back, especially after a course of corticosteroids

References

1. Matsumoto DOI: http://dx.doi.org/10.1007/s00586-012-2500-z
2. Choosing Wisely