Scans and Investigations: Things Have Changed
Referral for investigations such as x-ray, ultrasound, CT or MRI scans is an expectation that has developed considerably over the last few years. The belief that having a scan will show exactly where the pain is coming from is one that is strongly held by many people. Due to the high quality of pictures produced by imaging equipment such as MRIs, we are able to see even the smallest change to various structures in the body. As health professionals, we can find this extremely helpful to assist with and confirm the diagnosis of a certain injury, determine prognosis for that injury and help guide the rehabilitation process. Investigations should always be accompanied by an in-depth interview to gain an understanding of the history of the injury, as well as a thorough objective assessment which leads to a diagnosis that MATCHES the results of the scan.
As mentioned, there is a widely held belief that whatever shows up on your scan is ALWAYS the cause of your pain. THIS IS NOT TRUE. What we know from the current research in this area, is that it is very normal to have changes in various parts of your body as you age.
It is even common to have changes around the ages of 20 or 30. Everyone is different and there are a number of factors that contribute to the rate at which certain joints change. For example; genetics, past history of injury or illness, history of employment etc. The other interesting fact is that just because a joint or area of the body has some change, it does not mean it has to be painful! This is confirmed in a study done in 2015 where researchers performed MRI scans of the lumbar spine (lower back) of 100 people in various age groups from 20 to 80 years old, all of which had NO PAIN. What was found is that as much as 80% of participants had some form of change in their spine, but none of them had any history of lower back pain.
These results are not limited to the lower back, similar findings where found in other joints including the neck (87% had varying degrees of disc
bulging, but still had no pain!), the shoulder (40% had rotator cuff changes, 72% had labral (cartilage) changes , 78% had thickening of the bursa) and the knee (68% had changes in the cartilage and 72% bony spurs). These figures provide us with clear evidence that change in joints, discs and cartilage is normal part of the ageing process and are not always to blame for pain.
As mentioned, investigations can be highly beneficial in determining the degree of injury, if any, to certain structures. However, care MUST be taken with interpreting the results. Linking the results of a scan with the history and presentation of the pain is the best way to determine whether or not the findings are relevant to the person’s problem.
So, what if we determine that the changes on the scan are not consistent with the history, presentation and assessment of the painful area? Working with your Physiotherapist to determine other factors which may be contributing to your ongoing pain is the next step in getting you back to doing the things you enjoy. For more information on this topic please do not hesitate to contact us on (07) 4051 3252 or book online