Getting imaging for low back pain (LBP) is very common practice, with 42% of clients with LBP receiving an X-ray, CT, or MRI within 1 year of diagnosis. While it may be intuitive to get imaging for an acute episode of LBP, there are several reasons why it may in fact cause more harm than good.  

Firstly, what the research has found is that the “findings” on imaging are often not correlated with the symptoms of your LBP, meaning the “findings” are not likely causing your pain.2 Studies have found that if you scan healthy people with no LBP, there is a very high prevalence of abnormal image findings such as “spondylosis” and “degeneration”.2 This prevalence of abnormal image findings in a healthy population increases with age, 2 as seen in the Table 1. Consequently, imaging is not indicated for LBP in the absence of red flags, on the basis that the rate of abnormal imaging findings is high in healthy people and do not correlate well to your symptoms. 

Table 1. Prevalence of abnormal image findings in people with no low back pain (LBP).2 

Secondly, the imaging results may be misinterpreted by clinicians and can result in unhelpful advice, needless subsequent investigation, and potentially even invasive interventions, such as surgery.1 whilst invasive interventions may be warranted in some cases with identified red flags, the vast majority of people with LBP can be managed non-surgically and can have equally as good outcomes.  

Thirdly and most importantly, misinterpretation of image findings, such as “degenerative disc disease”, “disc protrusion” and “foraminal narrowing”, can result in catastrophisation of the condition, which is defined as a person viewing their situation as considerably worse than it actually is. Catastrophising promotes an extremely unhelpful belief in people that their spines are structurally damaged and vulnerable.1 consequently, clients often become more fearful of movement and activity, and usually opt for bed rest. This contrasts with best practice for acute LBP, as bed rest and immobility are not recommended compared to staying active within pain limits, and that advice to stay active had greater benefits in pain relief and functional improvements.3 Clients misinterpreting their image results also lowers their expectations for recovery as a study found that the early use of MRI for LBP resulted in increased disability, poorer perceived prognosis and a greater chance of undergoing back surgery.1  

In conclusion, in the absence of red flags, imaging for low back pain is contraindicated as image findings do not correlate with symptoms and may promote detrimental beliefs about LBP that can worsen outcomes. The red flags which would warrant imaging for LBP are severe and/or progressive neurologic deficits, LBP that is constant and does not change with movement, and incident of trauma. Engaging with a health professional, such as a physiotherapist, will assist in ascertaining the presence of red flags and suitability for imaging. 

References

1. 1. Darlow, B., Forster, B. B., O’Sullivan, K., & O’Sullivan, P. (2017). It is time to stop causing harm with inappropriate imaging for low back pain. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816. 
   2. Dahm, K. T., Brurberg, K. G., Jamtvedt, G., & Hagen, K. B. (2010). Advice to rest in bed versus advice to stay active for acute low‐back pain and sciatica. Cochrane database of systematic reviews, (6).