It hurts! Do I need an MRI or X-Ray?
Aches and pains can make us anxious. What could possibly be going on inside our bodies!?
One way to find out is by having diagnostic imaging, such as an X-ray, CT Scan, Ultrasound or MRI.
You may ask yourself if you need imaging to find out where your pain is coming from, and whether or not it will it lead to a better outcome. However, current clinical practice guidelines advise against the use of routine diagnostic imaging for most musculoskeletal disorders unless something serious is suspected. Several studies show that routine imaging for musculoskeletal disorders does not improve clinical outcomes and may lead to unnecessary costs and procedures.
If we cannot see or identify the problem, how do we figure out what is causing the pain?
The honest answer is that pain is complex, which makes it difficult to determine the exact root cause of it, even with imaging. Research consistently shows there is a weak relationship between what is seen on imaging and pain, meaning structure does not always predict function.
Fortunately, from a thorough clinical examination we can get an excellent idea of what is causing your symptoms and a build a plan from there.
Often, when radiologists are creating a report of someone’s scan (i.e. an MRI or X-ray report), they often find ‘abnormalities’ or scary-sounding terms such as tendonitis, bursitis, degenerative disc disease, disc herniations, muscle tears or joint space narrowing. But what is often not communicated is that most of the population have these exact same abnormalities, even without experiencing pain! These abnormalities arise at the age of 18 to 20, and are associated with normal age-related change. If wrinkles on our faces don’t hurt, the same can be said for our internal aging.
Imaging for musculoskeletal disorders can be useful for ruling out serious conditions or guiding further medical intervention such as surgery or injections. Beyond this, it is debatable if it changes the management of a particular condition.
The majority of muscle and joint pains do not need medical imaging. Your health care practitioner is trained to identify who may need further medical testing, and if it isn’t required, simply continue with regular-graded physical activity as your best medicine for life’s aches and pains.
By Sean Overin, Physiotherapist