This is something I am asked a lot in physio consults, and it’s a completely valid question. When you’re in pain or struggling with an annoying injury, the thought of having a look “inside” with an Xray / MRI / CT / Ultrasound so that you know exactly what is going on is very appealing.

But my answer to this question is more often ‘No’ than ‘Yes’. Or at least ‘Not yet’.

The two reasons I tend to recommend imaging are:
1️⃣ If I think the results may change the way we treat the pain/injury
2️⃣ If I think the results may change our expectation of recovery timeframes

Yep, they’re pretty much the only two reasons! And here’s why:

🔎We don’t need imaging to know what is wrong. As physiotherapists, we are trained in assessment and diagnosis and we can use these skills to get a pretty good idea of what your injury is or which structures are involved.

🔎We don’t need to know what a scan says to treat you well. Often treatment is guided by how the injury/pain is impacting you and what you can and can’t do (you are a whole person after all, not a sum of body parts!) This is all information we can gain in a good assessment (not a scan).

🔎The information on scans does not always correlate with your symptoms. Did you know that disc degeneration is seen on ~68% of the MRI’s of 40 year-olds with no lower back pain?? I have seen people in terrible pain with scans that show nothing, and people with significant findings on scans without symptoms.

🔎A focus on scan results can have a real psychological impact that often affects your perception of pain. Image how you would feel if someone said ‘you have the spine of a spine of an 80 year old -it’s basically bone on bone’. Now compare that to ‘you have some irritation in your low back, let’s find a way to calm it down’. Scan reports can provide language that you fixate on. At best this is unhelpful and can lead to protective behaviours, decreased mobility, weakness, stiffness, and reduced resilience. At worst, it can result in unnecessary surgeries, excessive medical interventions, and prolonged rest.

So, does this mean I never refer for imaging?

Absolutely not! They can provide incredibly helpful information. In fact, I’ve referred two people just in the last week back to their GP for XRay & MRI referrals. But it’s almost always done after a good assessment first and a really good chat explaining the reasons; which are almost always:
– that it may change the way we treat the pain/injury, or
– it may change our expectation of recovery timeframes

Hopefully some of this information is new to you or helpful in some way! I’d love to hear your thoughts if you have any.