Between the well meaning but often under informed television shows, your friend’s cousin with low back pain, and the abundance of information online, there is an overload of information in regards to low back pain. Some information is good, some is bad, and some is just absurd. Over the course of next few months, we will be explaining some of the main misconceptions in regards to low back pain. Let’s start it off with one of the big ones, medical imaging and it’s place in low back pain.
“I need an x-ray/MRI to determine why I am having low back pain”
A common belief in most patients, however in the majority of cases, this is just plain not true, and can actually having imaging performed can actually hinder someone’s ability to recover from low back pain.
Most medical guidelines strongly recommend against physicians performing x-rays and MRIs when diagnosing low back pain, and recommend reserving medical imaging for individuals with significant neurological deficits. While an MRI will show you detailed information regarding the current anatomical details of your spine, it is not able to provide someone with a pathoanatomic diagnosis as to why they are experiencing the pain they are experiencing. Any innervated structure in the lumbar spine can cause the low back to hurt (facet joint, ligaments, thoracolumbar fascia, muscles, nerve roots, etc), therefore just because there is a herniated disc at L4-L5, this does not necessarily mean that this herniated disc is what is causing your pain!
For example, multiple studies have found that anywhere from 20-76% of individuals without low back pain have abnormal MRI findings (herniated disc material). Another study found that only 47% of individuals who were experiencing low back pain had abnormal MRI findings. This means that in individuals with low back pain, there is a 50-50 coin flip chance that an MRI will show something abnormal, and honestly, the abnormality seen may not be the pain generator.
Let’s ignore the financial costs to the individual, and the excess cost to the healthcare industry of unnecessary imaging, and talk more about the consequences imaging can have on the quality of life of an individual. The single biggest issue I see with improper imaging is that it creates fear. The minute someone is told they have degenerative disc disease or a disc herniation at L4-L5, it begins to support a belief that their back is significantly damaged, and may never be the same. However, as we talked about earlier, there are numerous individuals walking around with horrible looking MRIs with zero back pain! I have spoke with people who have had imaging that revealed abnormalities, and for ten years, they lived in fear that the wrong movement or position could cause severe damage to their spine. This is the type of fear that excess imaging has the potential to create, and is best avoided unless serious circumstances require imaging.
This is why in physical therapy, we rely on movement testing and provide corrective movement strategies as opposed to using a patho-anatomic diagnosis to guide our treatment.
Now, of course there are exceptions to the rules, where imaging is a necessity for the patient and their course of care. If you are experiencing acute low back pain, and are not experiencing significant weakness or sensory loss in the legs, I would encourage forgoing imaging and proceeding with conservative care to alleviate your pain levels.