IMAGING - DO I NEED AN MRI, CT, X-RAY OR ULTRASOUND?
In short, it depends case by case. Let me elaborate a little more below so that you are informed!
For most clients, imaging is the equivalent of taking a photo of the car engine without actually looking inside to figure out what's going wrong.
By obtaining a thorough case history, we can gather information about a person’s movement, health and pain which is not provided through imaging.
This may come as a surprise to some, considering that imaging can produce some high definition images of the area of concern. Surely that would be helpful right?
Not always, and in some instances, it can be more harmful for a client. Quite often imaging can lead to a client becoming more fearful and uncertain about their pain, movement and safety. This doesn't help our recovery especially when these findings very possibly may have existed before the injury!
There is now emerging research to suggest that it is incredibly common for people to have irregularities in their discs, joints and spine without them even knowing!
For example, in your 40’s you have a 50% chance of having a disc bulge without feeling any symptoms
In a group of 100 people having their shoulders imaged, “if 50% of people had pain and 50% didn’t, a skilled practitioner would not be able to tell the difference by images alone” - Jo Gibson
This is because ‘pathological findings’ found in imaging are poorly related to an individual's pain. They are more akin to ‘wrinkles on the inside’ - we accumulate them as we age and often aren't painful (only maybe to look at!).
If you are curious to explore more, I will link the study below showing high rates of pathological findings in clients that are completely symptom free.
Imaging is a great tool in the following circumstances:
When we detect 1 or more 'red flag symptoms' which requires further investigating.
In traumatic instances when we suspect a fracture or ligament rupture.
A condition that is progressively getting worse (not just after 1 visit).
We aren’t responding to the treatment & management plan as expected.
Outside of this, assessing your structure doesn't show how we are going to improve your function, but a case history and assessment does. As practitioners we are highly qualified and trained to assess if we believe imaging may be needed.
In summary, if your health professional doesn’t opt for imaging, they are of the belief that it is not necessary in your circumstance and do not want to waste your time and money!
Imaging rarely changes how we manage your injury & pain. Have trust in your practitioner as they have your best interests at heart!
References
Brinjikji, W., Luetmer, P., Comstock, B., Bresnahan, B., Chen, L., Deyo, R., Halabi, S., Turner, J., Avins, A., James, K., Wald, J., Kallmes, D., & Jarvik, J. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology : AJNR, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173