Many patients with pain in their lower back are often after treatment and advice on ways to best to manage their condition. Osteopaths and other practitioners are trained in thoroughly assessing and examining someone’s body, and can determine a differential diagnosis that forms the treatment and management plan moving forward.

Every day we are faced with patients wondering whether they should have some sort of investigation into their pain – x-ray, CT or MRI. In respect to the lower back, MRI can be gold standard for diagnostic value, and will therefore identify problems with the vertebrae, intervertebral discs and soft tissues. However what it is not capable of, is determining the structure that is responsible for YOUR pain.

Studies in the field of back pain have revealed that imaging cannot reliably diagnose lower back pain, and often cause more false alarm. False alarms, or ‘Red Herrings’, are known as possible structural irregularities that MAY cause someone pain, however are not clinically diagnostic. This may be features of ‘wear and tear’ within the spine, having occurred over many years of an active or even sedentary life.

While the idea of having an MRI to visualise structures in the back is valuable and extremely tempting, we also must understand the complex outcomes of unnecessary imaging or poor interpretation of results. This can in fact INCREASE patient apprehension and therefore indirectly affect quality of life and lead to a poorer prognosis.  It is important for practitioners in the medical industry to accurately relate the MRI findings to clinical symptoms and manage accordingly with treatment techniques and lifestyle advice (Graves et al, 2012).

When your pain is not improving over a period of time, not responding to manual therapy, or if you present with any clinical red flag, then imaging is undoubtedly a valuable tool to use. This will change the way that your practitioner manages your condition, and may refer you on for further intervention or assessment as required.

At CSSM, we encourage patients to discuss their condition with their practitioner. Ensure that you understand YOUR pain, and ways to manage it when conservative treatment is appropriate rather than seeking answers through imaging methods.

Resources:
Graves et al, Early Lumbar MRI not associated with better outcomes, 2012.
Jensen 2010, Early MRI Use, COCA.
https://www.painscience.com/articles/mri-and-x-ray-almost-useless-for-back-pain.php