You Don't Need Imaging For You're Lower Back Pain
If there's one thing that almost everyone on this planet can relate to it's lower back pain. At one point or another almost everyone has unwillingly joined this brotherhood of back problems. Lower back pain is the number one cause of disability across the globe. Think about that for a moment; almost everyone ends up with lower back pain at some point and it is the greatest cause of disability. On the bright side, if you are looking for a solution you can rest assured that you are not alone.
Traditionally, when someone begins complaining of lower back pain their first instinct is to wait it out and see if it goes away on it's own. Once they've finally realized that they're simply enduring the pain instead of solving it, they decide it's time for a doctor's visit to see what's wrong. Unfortunately, most primary care physicians are not well equipped or trained to deal with pain. The doctor will then refer them out to either a specialist or to get imaging, which can be quite costly. Once the imaging comes back, the doctor typically then refers you to a physical therapist for further evaluation. The graphic above does a great job depicting this whole cycle. As you can see, the newer model where you go to physical therapy first, cost almost half on average ($2,100-2,200 compared to $900-1,000 total). Unfortunately, lower back pain is not a cheap thing to have either way, but the improvement in quality of life can be priceless.
You would think that because you payed more to get imaging done on your back, you would end up better off in the long run, right? Wrong. One study that demonstrates this very well, involved 246 patients with acute lower back pain and/or sciatica (numbness or tingling in their leg(s)). All of the patients in this study got imaging done but only half of them were shown the results right away. The other half were not shown their imaging until a year later. Both groups had similar outcomes, but the group that did not see their imaging right away reported feeling significantly better on their self-rated general health compared to the group who did.
Other considerations for whether or not to get imaging include: surgery and radiation. There is a strong correlation between incidence of advance spinal imaging and rate of surgery. This means that people who got imaging were more likely to get surgery, even though the majority of the cases could have been resolved with conservative measures such as PT. These patients then had to pay for surgery, recover from surgery, and many time go to PT afterwards anyways because the surgery did not fix the root cause of their pain. The other issue to consider with imaging is radiation. One round of lumbar spine x-rays have been shown to provide the same amount of radiation as 6 months of background radiation, which is the amount of radiation associated with normal daily living.
Why would you want to expose yourself to this extra radiation for something that will not give you a better outcome with your back pain or even cause you to get unnecessary surgery?
You wouldn't. That's why we're offering you a real solution to your pain. The healthcare system is still in the transition from the old approach to the newer model but you can be part of the new wave by making an educated decision on how imaging will affect you. If you'd like to learn more about the new healthcare model, read my blog post called "What Is Direct Access and Why You Should Take Advantage". To get a better idea of how we can help your specific situation, give us a call and speak directly with a Physical Therapist here at Rise Above PT.
I'd like to give a big shout-out to my good friend, Dr. Sam Nesbit for allowing me to use some of his ideas for this post. Below are the links to the research articles used.
Flynn et al, 2011, Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good
Hartvigsen et al, 2018, What low back pain is and why we need to pay attention