Is imaging worth the scanxiety?

Diagnostic imaging can be a great tool to narrow down a diagnosis, especially after an acute injury. The more common imaging that is done are ultrasound, X-ray, MRI, and CT scans, often a combination of the above. As with any diagnostic measure in the physiotherapy world, the results should be taken with a grain of salt. This is largely because the comment on the radiograph will cover anything that is seen, regardless of if it pertains to the symptoms felt. For example, you may receive a referral for an x-ray to rule out a fracture, however, the findings will also comment on the space between your joints. It is also understood that there is a poor correlation between the results of the imaging and pain experienced [1].

A common term that may be used is “degeneration”. However, it is important to note that degeneration, albeit can be a scary word, does not equal pain. A study of studies was done in 2015 where the researchers compiled 33 studies on imaging in the absence of low back pain and found that the older you get the more degenerative changes there are [2].

In the above table, you can see that disk degeneration is a very common condition, however, none of these participants experienced pain or disability! Similarly, you can apply this to other joints in the body such as your knees and hips. It is not uncommon for people in the community to have arthritis, for example, who are asymptomatic and can still live their life relatively pain free, with the occasional flare up. Does this mean that everyone who has arthritis in their hips will have pain? Not at all. A more appropriate term to describe this phenomenon would be “age-related change”.

As mentioned earlier, imaging can still be a great diagnostic tool. From a physiotherapist perspective we would only place a referral for imaging if it would impact the way we treat your condition. For example, if you had a fracture, the bone needs to be immobilised to allow time for the fracture to heal. However, if there is no fracture, it is likely that we can help to treat your pain.

So how do we treat if we don’t use a diagnostic measure? Physiotherapists will try to address muscle imbalances, coordination deficits, help with joint stiffness, and other lifestyle factors, and ultimately help you get stronger and more resilient so you can live your life.

If you would like someone to help make sense of your pain, please call us at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

1. Winkel DA, Geert; Matthijs, Omer; Meijer, Onno G.; Phelps, Valerie  Diagnosis and Treatment of the Spine: Aspen Publication, Inc, 1996.

2. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology 2015;36(4):811-16 doi: 10.3174/ajnr.a4173.