MRI & X-Rays – Over Reliance

by / Wednesday, 15 April 2015 / Published in Advice

Over –reliance on Imaging. MRIs and Xrays

Often I see patients who have had back, knee or shoulder pain  for a period of time usually they have seen their doctor who may have offered them  pain relief and often if the pain is not resolving they are then sent for a scan  such as an Xray or MRI. After they have had the scan then sometimes they attend physiotherapy. Usually the first time I see them they typically hand me the written report of the MRI  or Xray and proceed to tell me their disc are ‘worn’, their ‘discs are out’ or  they have worn cartilage in their knees etc and that this is the cause of their back or knee pain.

While technology  is of course a huge benefit, “Abnormalities” are often found on MRI or Xray without any relation to that person’s pain. In fact, seeing abnormalities is more common than seeing a “normal” spine!

I often see patients who may have had back pain for a period of time and went for an MRI which has shown they have a disc bulge, yet they only have pain in their back or buttock. They have no leg pain. They have no lower limb tingling ,numbness or loss of power in their leg which are symptoms you would expect to see in a patient with a symptomatic disc bulge.  In these patients, the pain generally has nothing to do with the disc bulge. A study has shown that at least 40 % of people between age of 20 -22 years of age have one degenerated disc and 25% have a disc bulge. This simply means that disc degeneration and disc bulges are normal as we get older.

Back pain and neck pain is often caused by soft tissues such as muscles and tendons. This is confusing because the patient may have been told that their pain is from their spine, discs, or nerves. The problem is most people as they get older have signs of wear and tear on their x-rays and MRIs, but these common signs of aging may not explain their  pain.

Just because MRIs and Xrays allow us to get a  clearer image of what’s going on inside our bodies this  doesn’t mean that we have a clearer understanding of what’s causing your pain. More than 90% of lower spine MRIs exams in adults are abnormal. Studies have found that disc degeneration is present in 40% of people between the age of 20 -22 and in 90% of  those between the ages of 50 and 55.

If disc degeneration was indeed a viable explanation for all back pain then 90% of people between 50 and 55 years of age should be suffering with back pain which isn’t the case.

Similar finding are found in the knee, shoulder and ankle as the diagram attached shows. While imaging MRI and Xrays are important in terms of a diagnostic tool they are only one part of the puzzle a good examination of muscle strength, function, posture and biomechanics also needs to be looked at .

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