"I need a scan, that will tell me what is going on inside my body!"
It's quite remarkable how far we have come with regards to imagery of the human body. For many years we relied on X-ray. X-ray only shows a negative of your bone structure and can identify a fractured bone, or the healing from an old, unidentified fractured bone. But X-rays do not show what we call soft tissue, for example; muscles, ligaments, tendons and organs. We now have Diagnostic Ultrasound (US), Computerised Tomography (CT) and Magnetic Resonance Imagery (MRI) at our disposal. And they all have their places. There is no hierarchy of imagery procedures. US is used for pregnancy, CT is used for stroke detection, for example. MRI Scans can show the spine and it's associated structures in great, accurate detail. it can show whether a spinal cord has a lesion, an impingement, prolapsed disc or degenerative changes to the small facet joints around the spine.
It is not limited to the spine. It is equally as accurate for the cervical (neck), shoulder and knee for example. So it might not be unsurprising that many patients who present to physiotherapy who have been suffering for what seems an eternity to them, feel they need a scan to know for sure what is going on, right? You can probably guess where this blog is going. It might not necessarily give you the true reason for the pain or problem you are presenting. I'll use the example of low back pain as it is the most commonly requested area of the body, for reassurance
It may come as a complete shock that it is a normal part of aging for the structures in your spine to undergo some degenerative changes as we age. Take the image above: If we were to take all of the 20 somethings in our local area and gave them an MRI who do not have low back pain the Scan will show something untoward. Therefore, does it stand to reason that you can have something going on inside your back and it not give you any problems?
Irrespective of age, it doesn't matter which aspect of the spinal structure you image, it will most likely have something going wrong with it. So, can it stand to reason, that the reason for your pain, if you can exist pain free with structural changes in your spine, might be what is most likely the reason for low back pain? Tight or over-active muscles!?
The sharp, shooting pain that you feel you are feeling is just as likely to be muscle over-activity! There are highly specific and sensitive tests we as physiotherapists can perform on you, to gauge a more accurate reason for the cause of your pain. If we were to scan you regardless and it shows the likely degenerative changes, as we treat you according to this, it will almost certainly overlook the reason you are in pain. For example: If you have a prolapsed disc in your spine, it is more common to ease this type of pain with arching you back (extension) style exercises. Additionally, we can reproduce your symptoms by lifting your legs up one at a time (passive straight leg raise). However, if the source of your pain is muscular in nature, your body will prefer to go in the other direction (flexion), IE: leaning forwards or hugging your knees whilst laying on your back. So it might stand to reason that if we gave you an MRI and it shows a prolapsed disc, yet your clinician feels your muscles are more the reason for your pain and we got you going into extension, this could make your pain worse? Furthermore, do you want a surgeon to consider you for surgery to remove that elusive piece of annoying disc that may not be the cause of your pain!? The same can also be said for the shoulder.
It is becoming more evident with research being conducted, that as we age, our body naturally tears our rotator cuff group of muscles in order for us to maintain full shoulder movement. Most people lead a pain free, full moving shoulder from this. Yet if we MRI your painful shoulder and it shows a tear and you decide to have this surgically repaired and you suddenly cannot move your arm like you did before and it is still painful, was the tear the source of your problem? Again, we as physiotherapists are able to to perform both highly specific and sensitive tests on you to gauge the real source of your pain. So yes, imagery will show you what is going on inside your body but it does not show you what is necessarily causing you pain. If your clinician is trying to discourage you from having a scan, it's not because they are trying to save valuable NHS money, it's because they are trying to prevent you from being falsely worried into what you have going on inside your body. There have been numerous studies conducted that show it actually causes more harm by advising a patient of their MRI results because they tend to what we term as catastrophise. This means they see the worst and act accordingly: Stop moving their backs, reduce their activity levels, mood lowers, confidence lowers for example. In fact, we want people with low back pain to do the opposite! Move it or lose it! Increase your activity levels! Don't be lead by the scan. They have their place but they also have their pitfalls.
