Lumbar Spine Imaging- Does what you see actually correlate to your problem ???

Many patients that experience low back pain are often told it is a muscle strain, or related to degeneration or ageing.

In our experience this is very rarely the case.

Most people that have muscle spasm and have been told by another health professional (such as a GP, personal trainer, another physio etc) it is a muscle strain are incorrect.

You may indeed have muscle spasm, but it is always in response to the underlying condition, which is the disc in the vast majority of cases. Many disc injuries fail to be diagnosed correctly until the disc is touching the nerve giving rise to sciatica. At that stage the diagnosis of sciatica is almost always recognised. The back/buttock pain that often preceded it for many months or years is often the disc bulge, just not bulging far enough to squash the nerve yet to give rise to symptoms in the leg, and yet is often not diagnosed correctly until the development of leg symptoms.

Often when pain is severe in the back, or starts to travel down the leg patients are advised to get ” a scan”.

X-ray is really only useful if there is a fracture (as it predominately shows bone and does not image soft tissue such as the disc).

CT scans can be bulk billed and are so often performed, but they are not great at imaging the disc either and are much more useful for suspected bone lesions such as a stress fracture.

MRI is the investigation of choice for low back problems, especially if the disc is suspected.

But MRI scanning is often not necessary and does not always help management!

One of the key reasons for this is that the MRI is performed in lying, which is the position in which the disc bulges the least. And so an MRI done while sitting slouched paints a vastly different picture to one in lying which may come back “normal” even though the patient is clearly suffering from symptoms from the disc that are rapidly relieved and rectified with the McKenzie approach.

The other key problem with the MRI is that it reveals many things that may not be related to your clinical presentation.

A typical example of this is the patient who clearly has signs and symptoms of a disc bulge, but the MRI reveals only the most minor of disc bulges (which you are incorrectly told is not relevant), and yet it shows moderate facet joint degeneration or disc degeneration.

These findings especially in younger patients are rarely correlated with your problem, and it can cause great concern when patients who are in their 20-30′s are incorrectly told they have a degenerative problem they need to learn to live with.

Patients over the age of 55 will almost ALWAYS HAVE SIGNIFICANT DEGENERATIVE CHANGES, FACET JOINT WEARING AND SIGNS OF CANAL STENOSIS. But this happens in ALL people as they get older and is just “normal wear and tear” and is found is people who have NO LOW BACK PAIN.

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