At what point should I get imaging of my lower back done?
Low back pain is one of the leading reasons for medical visits in the United States. With the cost of health care rising steadily, diagnostic imaging and treatments for low back pain are being closely scrutinized for their cost effectiveness and efficacy in treating this population.
In 2007 the American College of Physicians and the American Pain Society published their guidelines for evidence based treatment of low back pain. According to these guidelines routine imaging (including plain film x-ray, MRI and CT scans) should not be performed for patients presenting with complaints of nonspecific low back pain, unless another more serious underlying condition is suspected.
X-rays may be obtained if there is suspicion of a compression fracture in high risk patients including patients with osteoporosis, or those patients with a history of long term steroid use. X-rays are also used if a patient sustains a trauma and there is risk of traumatic fracture. Routine use of advanced imaging, such as MRI and CT scan, is not correlated with improved outcomes and can identify anatomical abnormalities that may not be associated with a patient’s symptoms. The use of MRI and CT scans could also lead to unnecessary interventions.
Abnormalities found on MRI such as bulging discs, disc degeneration and arthritic changes are commonly seen on MRI even in asymptomatic people. If you have obtained an MRI and received the result performed by a radiologist it is important to remember that they are going to identify any abnormality found on imaging, regardless of whether it correlates with your symptoms. It is important to go over the results of your MRI with your physician to determine whether any of the results are significant. Advance spinal imaging is indicated if you are experiencing progressive neurological symptoms such as neurogenic weakness, progressive loss of sensation or spontaneous loss of bowel or bladder control. Even radiating symptoms, indicating possible lumbar nerve compression, are not an indication that advanced imaging is necessary. It is important to note that studies have shown that even symptomatic disc herniation with radicular symptoms tends to resolve within 4 weeks with non-invasive treatment.
One of the most important things to remember if you are experiencing an acute onset of low back pain is to keep moving. Pain is our body’s way of sending us a warning signal that something may be wrong. It is important to pay attention to what your body is telling you and modify your activities as needed, but remaining active is an important part of recovery. If you chose to visit your physician they may recommend physical therapy to further examine the source of your symptoms, and to instruct you on an exercise program so that you can increase your activity level while you allow your body to heal.
The author of this article is Whitney Rogers, PT, DPT, from Athletico – Bucktown Clinic.