Diagnostic imaging: a few words is not worth the picture

By: Jason Gallant, Registered Physiotherapist

I’ve seen it many times.  A nervous patient comes into my office with a concerned look on their face.  They hand me a copy of their recent X-ray, ultrasound, or MRI.  The first thing they say is that they have “osteoarthritis” or “degenerative disc disease” or a number of other foreign terms that show up on a diagnostic test.  It’s usually followed by something like “how bad is it?” 

Unfortunately, for many medical practitioners, their first instinct is to lean towards prescribing diagnostic tests to “find out what is going on” when someone has back or joint pain.  These tests aren’t often warranted and can end up doing more harm than good.  Patients are often given results of these tests and given a 1 or 2 word diagnosis without any education of what it means or how the results may or may not be affecting their pain.

At this point people start asking friends if they’ve had this, or Google the terms which only increases their worries about their condition.  By the time they see me they are scared of the long term effects of their diagnosis and wondering if there’s even anything I can do to help.  This is where I tell people that you are NOT your scan! 

Here’s the truth: when a radiologist looks at a scan their job is to find something, so they usually do.  That doesn’t necessarily mean that what they find has anything to do with your symptoms.  Many times, it is no more than natural age-related changes that happen to everyone.  A recent study looked at lower back MRI’s of healthy people with the average age of 45.  They had no low back pain at the time of the scan.  51% of those people were found to have degenerative disc disease and 61% were found to have disc bulges, but no low back pain! [i]

They followed up with another MRI 10 years later, and monitored their low back pain during that time.  The study concluded that their MRI results were not predictive of any future lower back pain, even though some of their MRI findings had worsened!

There is also a lot of variability in the findings of these scans.  A recent study was conducted on people suffering from chronic low back pain who received 10 different MRIs from 10 different places within a 3 week span.  The results of these scans showed 49 different problems, but not one of the findings was reported on all 10 scans![ii]

This is not to say that diagnostic tests should never be used.  They are important to rule out any major issues and ensure that you get an accurate diagnosis and fast treatment if it is an emergency situation.  But if you’re not showing any major signs and symptoms in an examination they can cause more harm than good, as their findings can worry people into thinking the worst.

So what does this all mean for you?  If you are having chronic lower back pain (over 80% of Canadians experience it in their lifetime) and wondering if you need an X-ray, MRI, etc, a good physiotherapist can do a thorough assessment of your issues and determine whether or not it is warranted.  Have you had a diagnostic test and are worried about what the results mean?  Don’t worry!  A good physio can explain to you exactly what these findings mean, and see if and how they correlate with your movement and pain patterns.  More often than not, these findings can have little to do with your pain, and more to do with natural changes in your body.  Treatment including proper education about your pain, and a home exercise program have been found to be most effective in relieving chronic pain and getting you back to what you love to do best!

[i] Tonsu, J et al.  The associations between magnetic resonance imaging finding and low back pain: A 10-year longitudinal analysis.  PLos One, 2017 Nov 15;12(11)

[ii] Herzog, R et al.  Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period.  Spine J, 2017 Apr; 17(4):554-561