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Physiotherapy, Osteopathy

Acupuncture & Pilates

Your painful back: to scan or not to scan?

In a quiet moment I recently shuffled through my embarrassingly extensive personal MRI collection (back, neck, right shoulder, left shoulder, right foot/ankle x3, left foot/ankle ahem x5, liver....) and mulled over whether all had been strictly necessary and whether they had changed my treatment

At about £500 a toss that's a lot of money (thank you Bupa, PPP and my parents!) and I haven't even mentioned all those bone scans, CT scans, ultrasounds and bone density scans. Oh, and all the xrays.
Wow! Can you believe I'm still a functioning human being let alone a manual therapist?

  Here's a scan of my back which I had done last year when I was trying to get to the bottom of the pain in - well, my bottom. I'd been suffering from a persistent and worsening pain in my left buttock which was taking over my life. Both walking and sitting were a disaster. In fact I was only really comfortable when I was working. Not an ideal state of affairs.  I saw physios, osteopaths, chiropractors. All good people. Everyone thought the pain was coming from my back and pelvis (so did I) but couldn't fix me. In trepidation I swung a referral for a scan. Had the scan and freaked - yikes what a lot of degeneration, what on earth is happening to my L5, how come I'm not in even more pain?  And what's that shadow on my liver? Oh God, now a referral to a liver specialist, more scans, told not to worry those cysts are not abnormal "at your age"

Well, it wasn't my back which was the problem. I'm fixed but that story's for another day.
And the liver is fine.  

My hypochondria has settled, too, thanks. 

But how fascinating to see all that degeneration on an MRI scan but actually to have no problem with my back other than an occasional golfing glitch. You don't need to be a medic to see that this is a worn spine!

Which leads me to the reason why I decided to write today's blog. So many of our patients come to us with painful backs and if we fail to fix them in one session they start asking us whether they should have an xray or a scan. No.  No.           No, no, no!!

Far too much time and money is wasted on scanning backs. They are wasteful and in the case of xrays expose you to an albeit small dose of radiation.
You only need a scan or xray if your physio or doctor:
1.  wants to screen you for something more sinister than mechanical low back pain
2.  is actively considering that surgery might be an option
3.  suspects that you are such a worrier that no investigation = very slow recovery

The third option is by far the most common reason why people manage to persuade their doctors to organise scans or xrays for them. We know that worried patients don't get better until they feel reassured.

Grey hair??
While the MRI scan represents a very sensitive and accurate assessment of spinal anatomy, it can't distinguish between painful and non-painful structures in the spine. In fact, a patient may have severe back pain but have an MRI scan that shows a relatively normal-looking spine; or conversely may have no back pain but the
MRI scan reveals a lot of anatomical problems. Patients can often be quite worried by 'dramatic' descriptions of what scans show. A loss of water content in a disc makes it look darker than others. This can be normal. It can be described as 'degenerative discs' a term that might cause concern, but if it were described as 'a bit like getting grey hair' that may (or may not!) be less frightening. Normal discs will 'bulge', and this is not the same as a disc 'prolapse'. A disc prolapse can sometimes be entirely pain free, but will sometimes cause symptoms.

Studies have shown that if we scanned one hundred adults who have never had back pain, we might find bulging discs in 50 of them. In other words degenerative disc disease or bulging discs do not necessarily provoke pain. So - why bother to scan in the first place?

Please be reassured in advance: the vast majority of our patients who present with back pain do NOT need surgery and do NOT have cancer!
Even me!



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