Why we need to be careful when it comes to imaging!

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One very common question we get in the clinic is; will I need a scan? When we get asked this, a patient is asking if they are required to be referred for some sort of imaging to assess their injury or concern. It may be what they are used to with previous injuries, maybe a friend has told them they need one, or they think it’s always good just to ‘double check’ the diagnosis.

“The truth is, however, that there a lot more scans or imaging being done than their probably needs to be.”

There are a couple of reasons why we should be cautious when it comes to jumping to get a scan- the main one being that a lot of findings are quite normal!

But how can it be normal to have a ‘bulging disc’ in my back (for example)?

“Many studies have shown that imaging ‘findings’ can be quite common in the non-symptomatic population.”

For example, a recent study looked at how ‘abnormal’ findings can commonly be present in magnetic resonance imaging (MRI) of the cervical spine (neck). They completed MRI on over 1,200 healthy individuals, of which 87.6% of them had disc bulging. What was interesting was that even a high proportion of 20-year old’s (around 75%) had some level of disc bulging (Nakashima et al., 2015). The knee is also another interesting area when it comes to MRI. A review of 63 different studies in 2018, showed that as people get older, osteoarthritis (OA) features become more common, even without pain. For people over 40, the prevalence of OA features can range between 19-43% in the non-symptomatic population (Culvenor et al., 2018).

So I shouldn’t bother about getting a scan?

Different forms of imaging can definitely be helpful when it comes to making a diagnosis- but the important thing to think about is that a scan doesn’t show the whole picture. It can also be very common for someone with pain to come back with a scan that doesn’t seem to show anything wrong! 

You might be someone that has recently had a scan and been told by a health professional that you’ve got a really bad ‘bulging disc’ or a knee that is ‘bone on bone.’ What you need to remember is that imaging alone does not predict what your outcome is going to be. This is where your physio comes into play, to assess the whole picture and ideally give you confidence on improving the things that maybe you can’t see on your scan!

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AUTHOR: JARRYD CROXFORD - Physiotherapist

Culvenor, A., Øiestad, B., Hart, H., Stefanik, J., Guermazi, A., & Crossley, K. (2018). Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British Journal of Sports Medicine, 0, 1-12.

Nakashima, H., Yukawa, Y., Suda, K., Yamagata, M., Ueta, T., & Kato, F. (2015). Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine40(6), 392-398.