Imaging Doesn’t Always Tell The Whole Story

Many times after an injury, one of the first steps can be to obtain imaging (xray, MRI, CT scan). This is sometimes a necessary step as it may be needed to rule in or out some more serious injuries that may require immediate attention, especially in the cases of traumatic injuries. But for many non traumatic injuries or chronic pains, they are not always a necessary first step of the treatment process. This is partly because having “abnormal” findings on an image does not necessarily mean it is the cause of your pain or that you will even have pain at all. Imaging looks specifically at anatomy, whether it be of bone or soft tissue, but it doesn’t always have to equate to symptoms.

We know that pain is multifactorial and complex and goes beyond just tissue damage or pathology. Pain is also influenced by things like sleep, nutrition, etc as well as non-physical factors like anxiety, fear, stress, and previous experience with injuries. Beyond that, numerous studies have found what would be categorized, on most imaging reports, as abnormal in individuals that have no symptoms at all and that is what we want to highlight below.

In 2015, a study (1) was published that looked at over 1200 volunteers (ranging in age from 20-79 and with a variety of jobs both physical and non-physical) that had no symptoms of neck pain. MRI’s were performed of their necks and found that the vast majority, over 87%, of these individuals had some degree of disc bulging. The number of levels and severity of disc bulges did increase significantly with age. There was also a small percentage that had findings of spinal cord compression (5.3%) and increased signal intensity (2.3%), which is typically a sign used to determine tissue pathology with MRI, but once again none of these individuals had symptoms. The authors biggest conclusion from these findings was that if imaging has been performed, healthcare professionals cannot always use just imaging results to determine treatment plan but rather as just one component of the evaluation and development of a plan of care.

Another study (2) that was a systematic review of 33 studies, looked at MRI or CT scans of the low back for over 3000 asymptomatic individuals. This review also found an increased prevalence of “abnormal” findings with imaging including disc degeneration, disc bulging, and disc protrusions. It showed that starting at age 20 at least 30% of these individuals had disc degeneration, bulging, or protrusions. This review also found similarly to the study above that frequency of these findings increased with age. 

Once again, we are not saying that imaging is never needed but we want you to be aware that “abnormal” findings on an image does not necessarily equate to your symptoms. As Physical Therapists we perform thorough evaluations and use subjective history and objective findings with examination to determine course of treatment and imaging is just one component of that. If you are having pain or have an injury and are not sure where to start, you can come in for a FREE consultation where we will discuss your symptoms and evaluate your area of complaint as well as screen other surrounding areas to determine possible cause. In the state of Florida, we can evaluate you and begin treatment without a physician order. If you have further questions or want to set up your free consultation, please email us at info@performancesportphysio.com or call/text 727-826-7142.

REFERENCES

1. Nakashima H, Yukawa Y, Suda K, Yamagat M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine (Phila Pa 1976). 2015; 40(6): 392-398.
2. Brinjikji W, Luetmer PH, Comstock BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015; 36(4): 811-816.