Do I need imaging if I have lower back pain?

Lower back pain is one of the most common musculoskeletal complaints, with estimates suggesting that 70-90% of people will report an incidence of back pain in their lifetime (1) . But does referral for an X-Ray or MRI help with diagnosis and treatment? In most cases, imaging does not provide a clear diagnosis or direct treatment. Studies have shown that there is weak correlation between findings on imaging, and the symptoms that the patient describes. In fact, many findings on imaging are also found in asymptomatic patients. These findings are usually reflective of ‘wrinkles’ that are a normal part of the aging process. For example, >50% of people aged 30-39 have signs of disc degeneration and disc bulge on MRI, yet report no pain (2) .

In terms of diagnosis, statistics show that only 8-15% of patients with back pain have a specific patho-anatomical diagnosis (3) ; meaning that there is a specific anatomical source of pain. The remainder of patients have ‘non-specific lower back pain’. For the most part, imaging doesn’t provide any clinical benefit for this group of patients.

Our role as physios is to determine the factors that are contributing to an individual’s experience of back pain, and to then work with the patient to return to normal function.

SOURCES 1. Australian Institute of Health and Welfare. Australian Back Pain Snapshot 2018 [Available from: https://www.aihw.gov.au/reports/chronic- musculoskeletal-conditions/back-problems/data. 2. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR American journal of neuroradiology. 2015;36(4):811-6. 3. O'Sullivan P. It's time for change with the management of non-specific chronic low back pain. British journal of sports medicine. 2012;46(4):224.

BlogMiranda O'Hara