Do you need a scan for your back pain?

Up to 84% of the general population will experience back pain in their lifetime. While the onset for back pain can be quite distressing, most people believe that a scan (for example an X-ray, MRI) will help to identify the cause of their back pain and will help guide their treatment plan and determine if they require surgery. However, scientific research has shown that scans are only needed when a serious condition is suspected (cancer, fracture/broken bone, infection). Luckily, these serious conditions are rare and account for approximately 1% of all back pain worldwide. Imaging also places huge demands on healthcare resources such as waiting times, financial expense etc.

The problem with having a scan is that it will almost always show something and much of this 'stuff' is poorly linked with back pain. For example, studies have demonstrated imaging findings of disc degeneration, protrusions/herniations in a large proportion of asymptomatic individuals i.e not experiencing low back pain. In the image below, taken from a recent scientific study, people who don’t have back pain were shown to have disc bulges (30% of 20-year-olds, increasing to 84% of those aged 80), disc degeneration (37% of 20-year-olds increasing to 96% of 80-year-olds), disc protrusions (29% of 20-year-olds increasing to 43% of those 80 years of age) and arthritis (4% of 20-year-olds increasing to 83% of 80-year-olds). These results help to demonstrate that imaging findings are a part of normal aging and can often be un-associated with pain.

While back pain can be very painful and worrying, it is very common and rarely dangerous and often doesn’t require invasive surgical procedures. There are many factors which can contribute to these age-related changes becoming painful and this can include our thoughts and behaviours towards our back (thinking it is vulnerable and needs to be protected), our mood (stress) and how we naturally cope with pain.

Most often, in cases of low back pain, pain is derived from people moving differently and undergo pain related changes in the surrounding muscle and joint activity, for example abnormally high activity of superficial spinal muscles and low activity of the deep stabilizing spinal muscles, giving the impression that something has gone out of place. However, scientific research has clearly shown that these structures do not go 'out of place' or 'slip'. Therefore,the use of manual therapy, exercise and keeping active helps to restore this balance by creating changes in the nervous system and muscle relaxation and giving people the confidence to move as they usually would.

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