Should I Get An Xray?
Low back pain is a common and often debilitating condition that affects people of all ages and lifestyles. Many people want to turn to medical imaging, such as X-rays or MRI scans, to help diagnose the cause of their pain. However, recent research has shown that imaging is often unnecessary for low back pain and can even do more harm than good.
Studies have shown that many people without low back pain have abnormalities on imaging, such as herniated discs or degenerative changes. In asymptomatic individuals (people without any pain) undergoing an Xray on the lumbar spine showed that 80% over the age of 50 have a visible disc herniation. In twenty year old 25% of individuals without any back pain still showed signs of a disc herniation.
Conversely, many people with low back pain have no abnormalities on imaging. In other words, the results of imaging tests may not accurately reflect the true cause of a person’s pain. Imaging for low back pain can also lead to over-treating the back pain. When abnormalities are found on imaging, doctors may be more likely to recommend aggressive treatments such as surgery or injections, even if these treatments may not be necessary or effective. This can lead to increased avoidance of activity, patient anxiety, and potential harm from unnecessary treatments.
Recent guidelines from medical organizations such as the American College of Physicians and the American Academy of Family Physicians have recommended against routine imaging for low back pain. Conservative therapy such as physiotherapy, massage therapy, naturopathic medicine and chiropractic is generally the recommended approach.
Of course imaging still has its place if symptoms continue to worsen or if you show any signs of red flag; Such as bowel/bladder dysfunction, severe neurological deficit, groin numbness, malignancy, fracture or infection.
Brinjikji, W. et al (2014). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology
Jani Takatalo et al (2009) Prevalence of degenerative imaging findings in lumbar magnetic resonance imaging among young adults. Spine
Wáng Y. et al (2018). Informed appropriate imaging for low back pain management: A narrative review. Journal of Orthopedic Translation.