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Navigating the Maze: When to Pursue Scans for Lower Back Pain? - A Physiotherapist's Perspective.




Hey there, fellow back pain warriors! If you're reading this, chances are you've found yourself in the frustrating and often debilitating world of lower back pain. As a physiotherapist, I've walked alongside many on this journey, and today, I want to delve deeper into the question that often crops up: when is the right time to consider getting a scan for your lower back issues?



1. Understanding the Back Story


Let's start with the basics. Your lower back, or lumbar spine, is a complex structure comprising bones (vertebrae), muscles, ligaments, and nerves, all working in tandem to support your body and facilitate movement. When something goes awry – be it a muscle strain, disc herniation, or spinal stenosis – it can throw a wrench into your daily activities and leave you grimacing in pain.



2. The Symptom Conundrum


So, when should you start considering a scan? It boils down to the symptoms you're experiencing. While occasional twinges or stiffness might not raise any alarms, persistent and severe pain, particularly if it radiates down your legs, could signal a deeper issue warranting investigation. Similarly, if you're experiencing numbness, tingling, or weakness in your lower limbs, it's time to sit up and take notice.



3. Spotting the Red Flags


Ah, the dreaded red flags – those warning signs that warrant immediate attention. While most cases of lower back pain are benign and resolve with time, certain symptoms should raise alarm bells and prompt you to seek medical evaluation without delay. These red flags include:


• Sudden onset of severe pain, especially after a traumatic event such as a fall or car accident.


• Difficulty controlling your bladder or bowel function, which could indicate a serious condition known as cauda equina syndrome.


• Unexplained weight loss, fever, or night sweats, which may be indicative of an underlying systemic illness or infection.


• History of cancer or recent infection, as certain malignancies or inflammatory conditions can manifest as back pain.


If you experience any of these red flags, don't hesitate to seek medical attention promptly. While they may not necessarily indicate a need for immediate imaging, they warrant further evaluation to rule out serious underlying pathology.



4. Scan Options and Their Applications


When it comes to imaging for lower back pain, there are several options available, each with its own strengths and limitations. Here's a rundown of the most common scan types and the conditions they're typically used to assess:


• X-rays: These provide a detailed view of the bony structures of the spine and can help detect fractures, degenerative changes, and abnormalities such as scoliosis (1).


• Magnetic Resonance Imaging (MRI): MRI scans offer a comprehensive view of the soft tissues surrounding the spine, including the intervertebral discs, muscles, and nerves. They're particularly useful for identifying conditions such as disc herniation, spinal stenosis, and nerve compression (2).


• Computed Tomography (CT) scans: CT scans provide detailed cross-sectional images of the spine and can be helpful in diagnosing fractures, bone abnormalities, and complex spinal deformities (3).


• Ultrasound: While less commonly used for imaging the lumbar spine, ultrasound can be useful for assessing soft tissue abnormalities, such as muscle tears or inflammation (4).



5. Weighing the Risks


But what about the risks associated with scans? Beyond the potential financial cost, there's also the risk of overdiagnosis and overtreatment. A study published in JAMA Internal Medicine found that among individuals without symptoms, up to one-third showed evidence of disc degeneration or herniation on MRI scans (5). In other words, just because something shows up on a scan doesn't necessarily mean it's the cause of your pain with it also potentially leading to unnecessary treatment (6).



6. Collaborating with Your Physio


So, where does that leave us? It all comes down to collaboration – between you and your physiotherapist. Together, you can weigh up the pros and cons of pursuing a scan, taking into account your symptoms, medical history, and personal preferences. Your physio can also provide guidance on alternative approaches, such as targeted exercises, manual therapy, and lifestyle modifications, that may alleviate your symptoms without the need for imaging (7).



7. The Big Picture


In the grand scheme of things, getting a scan for your lower back pain is just one piece of the puzzle. While it can provide valuable insights into the underlying cause of your symptoms, it's essential to approach it judiciously and in the context of a comprehensive treatment plan. By staying informed, communicating openly with your healthcare team, and exploring conservative management options first, you can empower yourself to make the best decisions for your back health.



In Summary


When it comes to navigating the maze of lower back pain, knowing when to pursue a scan is crucial. By paying attention to your symptoms, understanding the evidence, and collaborating closely with your physiotherapist, you can chart a course towards effective pain management and recovery. So, listen to your body, stay informed, and remember... you're not alone on this journey!


Our Barnet, Cockfosters & Enfield Physio's have tons of experience in dealing with lower back pain. Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.



Blog By: Emre Oz (Musculoskeletal Physiotherapist at Crouch Physio).


References:


1. Imran, A.A.Z., Huang, C., Tang, H., Fan, W., Cheung, K., To, M., Qian, Z. and Terzopoulos, D., 2020. Analysis of scoliosis from spinal x-ray images. arXiv preprint arXiv:2004.06887.


2. Roudsari, B. and Jarvik, J.G., 2010. Lumbar spine MRI for low back pain: indications and yield. American Journal of Roentgenology, 195(3), pp.550-559.


3. Schroeder, J.E., Barzilay, Y., Kaplan, L., Itshayek, E. and Hiller, N., 2016. Value of repeat CT scans in low back pain and radiculopathy. Journal of Clinical Neuroscience, 24, pp.74-77.


4. Cheung, W.K., Cheung, J.P.Y. and Lee, W.N., 2020. Role of ultrasound in low back pain: A review. Ultrasound in medicine & biology, 46(6), pp.1344-1358


5. Brinjikji, W., Luetmer, P.H., Comstock, B., Bresnahan, B.W., Chen, L.E., Deyo, R.A., Halabi, S., Turner, J.A., Avins, A.L., James, K. and Wald, J.T., 2015. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American journal of neuroradiology, 36(4), pp.811-816.


6. Flynn, T.W., Smith, B. and Chou, R., 2011. Appropriate use of diagnostic imaging in low back pain: a reminder that unnecessary imaging may do as much harm as good. journal of orthopaedic & sports physical therapy, 41(11), pp.838-846


7. Foster, N.E., Anema, J.R., Cherkin, D., Chou, R., Cohen, S.P., Gross, D.P., Ferreira, P.H., Fritz, J.M., Koes, B.W., Peul, W. and Turner, J.A., 2018. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), pp.2368-2383.

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