At Sports & Spinal, one of the most common questions we get from patients is: “Do I need imaging to see what is going on?” It is completely understandable that people want imaging – when you’re in pain, you want answers and the thought of seeing “exactly” what is happening inside your body can feel reassuring.
However, imaging is rarely necessary. In fact, sometimes it can even be counterproductive to your recovery. There are a number of conditions that exist in an injured body that also exist in a healthy body. So let’s delve into when imaging is truly beneficial and when it might not be a great first step.
Firstly, why do people want imaging?
Peace of Mind
Many patients believe that seeing an image will provide definitive answers about their pain. There’s a natural human desire to “see” what’s wrong.
Validation of Pain
People often worry that without imaging, their pain won’t be taken seriously or that something serious might be missed.
Previous Experiences
If imaging helped diagnose a condition in the past, patients often assume it’s necessary for every new issue. Similarly if they know someone who had their condition successfully diagnosed with imaging, they can assume it is the only way to get an accurate result.
Media Influence
Elite level sporting clubs, television medical dramas and online health information can create the impression that imaging is always the first step in diagnosis.
When Medical Imaging IS Necessary
There are a number of cases where we will recommend imaging. Our therapist, using their expert knowledge and understanding of injuries, will refer for imaging when:
Red Flag Symptoms Are Present
- Severe trauma or injury
- Bowel or bladder dysfunction
- Neurological symptoms like extreme numbness, tingling, or weakness
- Unexplained weight loss
- Fever accompanying musculoskeletal pain
- Pain that worsens at night or doesn’t improve with proper rest
These red flags indicate serious pathology that requires immediate investigation (Greenhalgh & Selfe, 2010)
Conservative Treatment Hasn’t Worked
If you’ve been receiving appropriate treatment AND completing your exercises without any improvement over an extended period of time, imaging can help identify underlying structural issues that might be preventing recovery (Chou et al., 2011). BUT some findings are commonly incidental and can increase the patient’s anxiety about their condition unnecessarily.
Surgical Consideration
When surgery is being considered, detailed imaging is essential for planning and decision-making (Jarvik & Deyo, 2002).
Suspected Fractures
Following significant trauma, imaging helps rule out fractures or other serious structural damage (Stiell et al., 2001).
When Medical Imaging May NOT Be Necessary
Acute Lower Back Pain
Research shows that for most cases of acute lower back pain without red flags, imaging in the first 6 weeks doesn’t improve outcomes and may actually delay recovery (Chou et al., 2009).
Minor Sports Injuries
Many soft tissue injuries like muscle strains or minor ligament sprains respond well to conservative treatment without needing imaging (Bleakley et al., 2012).
Headaches and Neck Pain
Most headaches and neck pain are related to muscle tension, posture, or joint dysfunction that can be effectively assessed and treated without imaging (Bogduk, 2004).
Age-Related Changes
Normal wear and tear shows up on imaging even in people without pain. Studies have found that many pain-free individuals have disc degeneration, arthritis, or other “abnormalities” on imaging (Brinjikji et al., 2015). Research shows that 37% of 20-year-olds and 96% of 80-year-olds have disc degeneration on MRI, regardless of whether they experience back pain (Brinjikji et al., 2015).
The Practitioner’s Perspective: Clinical Assessment First
As healthcare practitioners, we are expertly trained to conduct thorough clinical assessments that often provide more relevant information than imaging. Clinical examination has been shown to be highly effective in diagnosing many musculoskeletal conditions (Cook & Hegedus, 2013). Here’s what we look for:
Movement Patterns
How you move, where movement is restricted, and what movements reproduce your pain tell us a lot about the underlying problem.
Physical Examination
Hands-on assessment of joint mobility, muscle tension, and tissue quality provides immediate, relevant information.
Pain Behaviour
Understanding when your pain is better or worse, what activities affect it, and how it’s progressing helps guide treatment decisions.
Functional Impact
How your condition affects your daily activities, work, and exercise is often more important than what shows up on a scan (Waddell, 2004).
Why Unnecessary Imaging Can Be Problematic
Incidental Findings
Imaging often reveals “abnormalities” that are actually normal age-related changes. This can create unnecessary anxiety and focus treatment on issues that aren’t causing your pain (Carragee et al., 2006).
Delayed Treatment
Waiting for imaging results can delay the start of effective treatment, potentially prolonging your recovery (Graves et al., 2012).
Increased Healthcare Costs
Unnecessary imaging increases healthcare expenses without improving outcomes. Studies show that early imaging for lower back pain increases healthcare costs by up to 40% without improving patient outcomes (Graves et al., 2012).
Radiation Exposure
X-rays and CT scans involve radiation exposure, which should be minimised when possible (Smith-Bindman et al., 2009).
Our Approach at Sports & Spinal
We believe in evidence-based practice that puts your recovery first. Here’s how we approach imaging decisions:
- Comprehensive Assessment: We start with a thorough clinical examination to understand your condition
- Red Flag Screening: We carefully screen for symptoms that require immediate imaging
- Treatment: Treatment can be wide and varied, but we always tailor it towards you, the individual. Many factors can influence this, including your injury history, date of birth, previous experiences and health literacy. We monitor your progress and discuss expected outcomes.
- Collaborative Decision-Making: We occasionally discuss imaging options with you if required, explaining when it would be beneficial and when it might not be necessary. We have long appointment times to ensure we have an adequate amount of time to
:+A+Practitioner’s+Guide){kind=link}