Low Back Pain and Medical Imaging: Gilbert Physical Therapy Explains What You Need to Know

Jan 29, 2016

Foothills Sports Medicine Physical Therapy

by Foothills Sports Medicine Physical Therapy

The Foothills Sports Medicine Gilbert physical therapy clinic proudly provides services to Valley residents, focusing on hand-on, individualized techniques to ensure optimal results. We offer a free consultation, which can be scheduled online here today. For more information about physical therapy and our practices, follow our blog.
Anastasia Schmaltz has a Doctorate of Physical Therapy and is a valued member of our South Gilbert physical therapy clinic’s staff. She is passionate about helping patients address pain and return to the activities they love. Today she is here to discuss back pain and how it is affected by medical imaging.
Unfortunately, 80% of us will have an episode of low back pain in our lives. When experiencing pain, a common response is to seek costly imaging tests such as x-rays, MRIs, or CT scans. However, there is reason to believe this should not be your first priority.
According to clinical commentary from the Journal of Orthopaedic & Sports Physical Therapy, imaging of the spine does not actually change the recommended treatment course, and may result in worse outcomes. Why would looking inside the body make your pain worse? Aside from being costly, excessive imaging has the potential to lead to radiation exposure, unnecessary surgeries and associated complications, negative labeling, and increased cancer risk.
Surprisingly, research has found that the occurrence of herniated disks and other degenerative spinal conditions are common even in people who do not experience pain. For example, the MRI results of a 62-year-old patient with intermittent low back pain and a previous bilateral hip replacement showed significant degenerative disk disease at multiple levels. This patient was able to complete a two-week backpacking trip through the United States Continental Divide without pain after undergoing 9 sessions of physical therapy, yoga, and exercise.
On the other hand, the MRI results of a 32-year-old patient whose chronic low back pain led him to take disability leave from his job were seen as “unremarkable,” and he was not deemed a candidate for surgery. After 24 sessions of physical therapy, he was able to return to work with moderate pain.
How can this be? The answer is complicated, but essentially these two examples show that damage to the spine does not automatically mean you will have back pain, and absence of damage or injury does not mean you will be pain free.
You might expect that imaging would give patients a sense of reassurance about what is going on in their bodies, but a study performed by Ash et al. showed that was not the case. Two groups of patients with low back pain and/or radiculopathy were given the same conservative treatment. One group was told their MRI results and the other was blinded to their results. After their treatments, both groups demonstrated similar clinical outcomes, but the group that received their MRI results reported decreased self-rated well-being. This suggests people tend to catastrophize their conditions, and imaging can have a negative psychological impact on patients without a positive physical benefit.
Some patients might seek imaging tests because they are worried they are ignoring something really bad that a scan could discover. However, studies have shown the prevalence of a serious pathology is very low. Only 0.7% of cancer is caused by low back pain, 4% is compression fractures, 0.01% is spinal infection, and 0.3%-5% is caused by ankylosing spondylitis. Imaging can be helpful in ruling out serious problems when additional symptoms are present, such as worsening numbness and weakness, and changes in bowel and bladder control. However, your doctor or physical therapist will screen you for these conditions and refer you to get imaging if necessary.
The physical therapy team at Foothills Sports Medicine is here to help answer your questions about medical imaging. We are happy to go over any results you get from your doctor, but we are more concerned with how you are feeling and what your goals are than what your MRI shows about your disks. We will allow you to return to a functional lifestyle without expensive testing or surgery, and more importantly we will help you become pain free.
Flynn TW, Smith B, Chou R. Appropriate use of diagnostic imaging in low back pain: A Reminder
That Unnecessary Imaging May Do as Much Harm as Good. J Orthop Sports Phys Ther. 2011;
41(11) 838-846. doi:10.2519/jospt.2011.3618.
Ash LM, Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki, Grooff PN. Effects of diagnostic
information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR.
June 2008 29: 1098-1103. doi: 10.3174/ajnr.A0999.

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