Low back pain: To scan, or not to scan? That is the question

Guest blog by Osteopath and Director of BodyMatters Clinic, Dr Oliver Thomson PhD

Many patients with low back pain (LBP) often ask me whether a scan is required, but the decision to scan is not always straight forward. So let’s clear a few things up.

Firstly, there are several different types of scanning procedures used to investigate back pain; we’ll focus on the two most commonly employed, namely X-Ray and MRI scanning. Briefly, X-ray is useful to show anything related to bony tissue in the spine, which consists of mainly the pelvic bones and the individual vertebra (spinal bones). As a rule, X-ray does not show any of the ‘soft tissues’ of the spine, namely the muscles, ligaments, nerves, intervertebral discs or cartilage. In contrast, MRI (which is short for magnetic resonance imaging) provides much clearer and detailed images of all structures related to the spine (bone, nerves and soft tissues). Both forms of scanning can be very useful in the diagnosis and management of specific instances of back pain.

One common misconception is that a scan (either X-ray or MRI) will be useful in most cases of LBP. However, for common ‘non-specific’ or ‘mechanical’ LBP (such as a sprain or strain to the muscles or ligaments of the back), a scan is rarely required, or in fact even very helpful. This is because there is a very poor relationship between what is seen on a scan and a person’s symptoms, e.g. pain, stiffness immobility.

For example, a perfectly healthy, pain free person may have an MRI scan which shows they have changes (‘damage’) to their intervertebral discs, or perhaps changes to the cartilage of their spinal joints, or even swelling or compression of the nerves coming from the spine. In contrast, a person with severe back pain may have an MRI which shows little-to-no changes to the spinal structures. This is complex nature of LBP. This scenario is frequently seen at the clinic and is supported by recent research, which shows that in a group of normal pain free people, up to 90% have degenerative discs and 30-40% had disc bulges or joint degeneration. The take home message from this is the mantra: ‘hurt doesn’t equal harm’; while back pain can be very disabling, painful and distressing it’s very rarely associated with any meaningful damage to the structure of the spine.

Dr. Oliver Thomson PhD

So what do I do about the pain, I hear you ask…

Exercise, movement and daily activities should continue and will typically be ‘sore, but safe’ to do (another useful mantra!).

Furthermore, research also suggests that scanning people with non-specific LBP can have negative consequences, as it causes patients to needlessly worry and focus on the scan results. It can also put them in a negative frame of mind and can cause them to avoid normal movement and exercise, which then impedes their recovery.

Scanning is only required when there are clinical signs that suggest more serious causes of back pain, or that there is significant damage to nerves in the area. However this is rare.

So, in summary:

  • Scans are rarely required or helpful in most cases of LBP.
  • Scans can be helpful if there are specific clinical signs which suggest a more complicated or more serious cause (this is rare).
  • If you’re not considering spinal surgery or spinal injections a scan offers little-to-no clinical value.
  • Most cases of LBP will resolve in 4-8 weeks.
  • Keeping active, advice from a health professional or a short course of manual therapy/spinal manipulation (such as osteopathy, chiropractic or physiotherapy) combined with exercise is usually all that’s required to help episodes of LBP resolve quickly.

To learn more about Dr. Oliver Thomson PhD and the work his clinic does, visit: www.bodymattersclinic.co.uk