How important and relevant are diagnostic images in the treatment and diagnosis of lower back pain.
Increasingly clinicians are turning to diagnostic modalities as a first point of call for lower back pain and seemingly terrifying patients in the process. To the non medically inclined receiving an investigation report with terms like circumferential disc bulge, severe stenosis, scoliosis, annular bulge and facet joint arthritis usually accompanies a quick Dr google search followed by misplaced panic and at times sheer terror.
Following this Physiotherapists as first contact practitioners tend to spend the first half of each appointment attempting to reassure patients that such investigations may have literally no clinical or practical relevance to their condition. In fact one recent study performed MRI investigations on lifetime asymptomatic patients. In these subjects 52% displayed a bulge at at least one level, 38% had an abnormality of more than one intervertebral disk. annular defects were found in 14 percent; and facet arthropathy, in 8 percent. The findings were similar in men and women. So what should we take from this? Given the high prevalence of these findings and of back pain, the discovery of pathology in people with low back pain may frequently be coincidental.
This does not mean however we should ignore all investigations and reports instead these should be well balanced with a clinical and functional picture presented to you by your practitioner.