When is imaging appropriate for lower back pain?
Being a physiotherapist I’m constantly amazed at both the amount and the frequency of quick referrals delegated to patients for various kinds of investigative imaging (CT, MRI, Xray etc). This is especially notable when it comes to lower back pain. Unfortunately in my experience a large degree of the time this is usually not just an exercise in futility but also one in how to best waste money in the shortest amount of time.
Why you may ask does sourcing what appears to be further diagnostic material seem to be nothing more than both a time and money waster in terms of helping patient progress? The answer can be defined simply as the problem with investigations are they can be TOO thorough! This may sound contradictory but a lot of the time imaging will display various forms of pathology that has no clinical relevance whatsoever in relation to your current pain or function levels!
I can still hear what your saying “and why does this matter?” Because a lot of the time this does nothing other than to panic the patient that the scan was designed to help!
In general the best and most reasonable approach to ordering investigations usually lies in the presence of confounding variables in a patients presentation. Put bluntly this means that if after basic treatment and a thorough subjective and objective examination has taken place there is no logical clinical picture that follows a distinct pattern it may be time to order investigations to identify the presence of a different pathology that is providing your symptoms. Generally speaking the unfortunate truth with Lower back pain is it can come on quickly with seemingly innocuous tasks and can feels incredibly and disproptionatly painful relative to the amount of injury you have incurred.