Breaking Common Misconceptions About Imaging of the Spine

Low back pain and neck pain are common causes for patients to seek care from a medical provider. 84% of individuals experience low back pain at some point, and around 70% suffer from neck pain. Patients often will inquire about whether imaging (X-rays & MRIs) is needed when this happens. Throughout this blog, we will address common misconceptions regarding imaging of the spine.

Misconception: When my back or neck is bothering me, I need imaging

Conservative management should be your first stop when having this. In fact, X-rays, MRIs, or CT scans can lead to expensive, unnecessary interventions, especially in the first six weeks³. Patients who underwent early imaging were 6x more likely to have surgery, 5x more likely to undergo an injection, and 4x more likely to have an ER visit⁴, all leading to an unneeded monetary burden on these patients.

Misconception: My MRI will always find what is causing my pain

Imaging often poorly correlates to pain concerning the spine⁵. Most abnormalities found in imaging for patients who have symptoms are also found in people who do not have symptoms. Management should be based on symptoms, not on imaging, as the correlation is often poor in non-specific cases of back and neck pain⁵.

Misconception: My imaging found some disc bulges and protrusions; my back is fragile

The spine is much stronger than we think, and many of these findings when imaging is performed are normal and are just signs of an aging spine⁶. Often these don’t correspond to symptoms. In fact, one study examined individuals who did not have any spine symptoms and found that disc degeneration, bulge, and prolapse all increase with age⁶. Starting at the age of 20, the positive findings of each were 37%, 30%, and 29%, respectively⁶. In the oldest population studied, 80 years old, the findings were 96%, 84%, and 43%, respectively⁶. These are individuals who are moving around without the symptoms of these findings. Again, the key takeaway is that these findings are NORMAL, and our backs are strong. Movement is medicine and is encouraged!

Misconception: My disc herniation is still there from the imaging I had five years ago

Disc tissues heal themselves over time. In fact, many studies demonstrate that the disc herniations reabsorb over time, and the worse the herniation, the more likely it will reabsorb. One study followed nine patients and found that spontaneous resorption of the herniated disc was found in all patients in a mean time of 8.7 ± 3.2 months. All patients recovered clinically in a mean time of 5.7 ± 1.6 weeks by conservative treatment. Large and/or sequestrated discs were associated with rapid resorption⁷.

Misconception: I cannot start physical therapy unless I have imaging, and if it finds disc herniations, physical therapy won’t help

This misconception is one of the greatest. In fact, physical therapy should be the first stop for you. Most states have direct access, meaning physical therapy can be your first stop for aches and pains. A lot of the research supports that physical therapy should be one of the first-line management for spine pain because less than 10% of spine-related pain requires surgery⁸. In one study that followed 148,000 patients, it was found that early PT resulted in an 89% reduction in opioid prescriptions for lower back pain and overall reduced costs, reduced surgery, imaging, and emergency department visits⁹.

Do you have lower back pain or neck pain related to the spine?

Athletico has clinicians who specialize in the treatment of the spine and have undergone training to facilitate better results! Call your local Athletico and schedule an initial evaluation of free assessment with a physical therapist FIRST to get feeling better faster! Ask for a spine specialist!

Request a Free Assessment

*Per federal guidelines, beneficiaries of plans such as Medicare, Medicaid, Tricare, VHA and other federally funded plans are not eligible for free assessments.

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Fourney DR, Andersson G, Arnold PM, et al. Chronic low back pain: a heterogeneous condition with challenges for an evidence-based approach. Spine . 2011;36(21 Suppl):S1-S9.
2. Sinnott PL, Dally SK, Trafton J, Goulet JL, Wagner TH. Trends in diagnosis of painful neck and back conditions, 2002 to 2011. Medicine (Baltimore). 2017;96(20):e6691. doi:10.1097/MD.0000000000006691
3. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-2803.
4. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs. Spine (Phila Pa 1976). 2012 Dec 1;37(25):2114-21. doi: 10.1097/BRS.0b013e31825d32f5. PMID: 22614792.
5. Rao D, Scuderi G, Scuderi C, Grewal R, Sandhu SJ. The Use of Imaging in Management of Patients with Low Back Pain. J Clin Imaging Sci. 2018;8:30. Published 2018 Aug 24. doi:10.4103/jcis.JCIS_16_18
6. Brinjikji W, Luetmer PH, Comstock B, Bresnahan 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 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. PMID: 25430861; PMCID: PMC4464797.
7. Elkholy AR, Farid AM, Shamhoot EA. Spontaneous Resorption of Herniated Lumbar Disk: Observational Retrospective Study in 9 Patients. World Neurosurg. 2019 Jan 3:S1878-8750(18)32938-3. doi: 10.1016/j.wneu.2018.12.115. Epub ahead of print. PMID: 30610984.
8. Just 10% of back pain requires surgery – and minimally invasive procedures work for many: Back and spine: Orthopaedics and rehab: UT southwestern medical center. Back and Spine | Orthopaedics and Rehab | UT Southwestern Medical Center. https://bit.ly/3uGju0O. Accessed March 29, 2022.
9. Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Serv Res. 2018 Dec;53(6):4629-4646. doi: 10.1111/1475-6773.12984. Epub 2018 May 23. PMID: 29790166; PMCID: PMC6232429.