X-rays, ultrasound, CT and MRI scans can be very valuable for identifying serious medical conditions such as fractures, spinal cord injuries and other specific lesions. However, once “serious problems” are ruled out by a radiologist, evidence shows that minor findings may not just be of no value in helping to explain the majority of aches and pains, they may be psychologically harmful especially when they tell patients that they have arthritis, degenerative disc disease, disc bulges, tendon tears and more.
Every day thousands of Australians become confused and distressed by medical imaging that doesn’t match the source or cause of their particular pain or problem. These people have been shown to have more doctor’s visits, more lasting pain, more disability and a lower sense of wellbeing.
Here are a few important facts regarding medical imaging that you must be aware of to prevent yourself from being fooled by your X-Ray or diagnostic scan.
Lumbar Spine – Lower Back
It is well established that most imaging findings, particularly degenerative changes, correlate poorly with clinical presentation.
Studies have shown that lumbar disc degeneration is present in 40% of individuals under the age of 30 and present in over 90% of people between the ages of 50 to 55.
Another study showed that amongst healthy young adults aged 20 to 22 years with no back pain, 48% had at least one degenerative disc and 25% had a bulging disc.
Leading physicians at the Department of Neurosurgery in California strongly recommend AGAINST the routine use of MRI for low back pain as they have NO LINK between degenerative changes seen on x-rays or MRI’s and low back pain.
Other research findings include:
1. Individual neuro findings on MRI (disc herniation, root compression, etc.) don’t provide a definitive link to LBP (Endean et al. 2011; Shambrook et al. 2011)
2. MRI does not improve clinical outcomes in the absence of red flags (Chou et al. 2009)
3. Early imaging does not positively impact clinical outcomes (Graves et al. 2012)
4. Inappropriate imaging can lead to misdiagnosis, inappropriate management decisions, potentially unnecessary surgery, poor outcomes and greater financial, social, psychological and physical costs (Flynn et al. 2011; Haldeman et al. 2012)
5. Spine MRI in primary care often leads to surgical assessment – yet MRI cannot discriminate surgical vs. non-surgical cases (You et al. 2012).
Translation: Do not panic if your x-rays show “problems” with your discs; they simply are normal changes that occur from the age of 20 onwards.
Thoracic Spine – Mid / Upper Back MRI studies of healthy adults with no history of upper or low back pain found that 47% had disc degeneration, 53% had disc bulges and 58% had disc tears in their thoracic spine. Amazingly, 29% of these healthy young people had a disc bulge that was actually deforming and pressing on the spinal cord, yet they had no signs or symptoms.
Translation: Do not panic if your x-ray or MRI shows “problems” with your discs; they are simply common and NORMAL findings.
Cervical Spine – Neck
An MRI study of healthy adults and seniors found that 98% of all men and women with no neck pain had evidence of “degenerative changes” in their cervical discs.
A 10-year study compared the MRI’s of healthy people to those with whiplash injuries. Immediately and 10 years later both groups had similar MRI’s with 75% having disc bulges.
There was also a recent study where they MRI’d the SAME patient in 10 facilities and got COMPLETELY different reports from all of them – not good!
Translation: The majority of all healthy adults get neck degeneration (arthritis and disc bulges meaning they are a NORMAL aging process! Therefore, neck arthritis and mild to moderate disc bulges can only be a reasonable explanation of your neck pain if they match your clinical examination.
MRI studies of adults who have no shoulder pain show that 20% have a partial rotator cuff tear and 15% have a full-thickness tear. In addition, in those 60 and older with no shoulder pain or injury, 50% (half) of them had rotator cuff tears on their MRI’s that they didn’t know about.
A study of professional baseball pitchers showed that 40% of them had either partial or full-thickness tears yet had no pain while playing and remained pain-free even 5 years after the study.
Translation: Do not panic if your ultrasound and/or MRI shows a rotator cuff tear; it is not necessarily associated with your shoulder pain!
There is only a weak association between joint space narrowing as seen on x-rays and actual symptoms.
In fact, one study showed that 77% of healthy hockey players who had no pain, had hip and groin abnormalities on their MRI’s.
Translation: Do not panic if your x-ray or MRI shows cartilage tears or narrowing; it is not a sign of permanent pain or disability.
Studies have shown that when x-rayed, up to 85% of adults with no actual knee pain have x-rays that show knee arthritis. This means that there is little correlation between the degree of arthritis seen on x-rays and actual pain.
In fact, one study showed that 48% of professional basketballers had meniscal (cartilage) “damage” on their knee MRI’s.
Translation: Do not panic if your knee x-ray or MRI shows degeneration, arthritis or mild cartilage tears; it is NORMAL!
Although there is an association with plantar fasciitis and heel spurs, it should also be known that 32% of people who have no foot or heel pain have a heel spur visible on x-ray.
Translation: One-third of all people have a heel spur and yet have no pain.
After reviewing this research you might be thinking that x-rays and diagnostic scanning are useless in identifying sources and causes of the majority of injuries and diseases. Not so. Diagnostic imaging techniques are valuable tools in assisting with diagnosis and healthcare management.
However, x-rays and scans are just one set of tools that provide unique insights that must be considered in the wider context of physical assessment and evaluation, as well as the social, psychological, nutritional status of a person. Only when all these factors have been considered, can an optimal healthcare management plan be devised and implemented to achieve the best health outcomes possible for you.
If you have an injury or pain that you would like to get better as quickly and completely as possible, please call Bodywise Health on 1 300 bodywise (263 994) and receive a no-obligation, complimentary injury assessment and advice.
In this session, you will discover the source and cause of your problem as well as the number one thing that you can do to help yourself get better.
References for Diagnostic Imaging of Musculoskeletal Injuries
- Kendrick D, et al. The role of radiography in primary care patients with low back pain of at least six weeks duration: A randomized (unblended) controlled trial. Health Technol Assess.2001: 5(30);1-69.
- Ash LM, et al. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR. Am. Neuroradiol. June 2008. 29 (6):1098-103.
- Modic MT, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on the outcome. Radiology. 2005 Nov; 237 (2) 597-604.
- Okada E, et al. Disc degeneration on MRI in patients with lumbar disc herniation: a comparison study with asymptomatic volunteers. Eur. Spine J. 2011 Apr;20(4):585-91.
- Matsumoto M, et al. Prospective 10-year follow-up study comparing patients with whiplash-associated disorders with asymptomatic subjects using magnetic resonance imaging. Spine. (Phila Pa 1976) 2010. Aug 15;35(18):1684-90.
- Matsumoto M, et al. Age-related changes of a thoracic and cervical intervertebral disc. Spine. (Phila Pa 1976) 2010. Jun 15;35(14):1359-64.
- Wood KB, et al. Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg. Am 1995 Nov;77(11): 1631-8.
- Cheung KM, et al. Prevalence and pattern of magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine. (Phila Pa 1976) 2009. April 10;34 (9):1934-40.
- Takatolou J, et al. Prevalence of degenerative imaging among young adults. Spine. (Phila Pa 1976) 2009. Jul 15;34(16):1716-21.
- Chou D, et al. Degenerative magnetic imaging changes in patients with chronic low back pain: A systematic review. Spine. (Phila Pa 1976) 2011. Oct 1;36 (21 Suppl):S43-53.
- Chu Miow Lin D, et al. Validity and responsiveness of radiographic joint space width metric measurement in hip osteoarthritis: A systematic review. Osteoarthritis Cartilage. 2011 May;19(5):543-9.
- 12. Silvis L, et al. High prevalence of magnetic imaging findings in asymptomatic collegiate and professional hockey players. Am J. Sports Med. 2011 Apr;39(4): 715-21.
- Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskel. Disord. 2008 Sep 2;9:16.
- Kaplan LD, et al. Magnetic resonance imaging of the knee in asymptomatic professional basketball players. Arthroscopy. 2005 May;21(5):557-61.
- Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur. Fact or Fiction? Foot Ankle Surg Am. 2012 Mar; 18(1):39-41.
- Sher JL et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-5
- Connor PM, et al. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: A 5 year follow up study. Am J. Sports Med. 2003 Sep-Oct;31(5):724-7.