Why won’t my doctor refer me for imaging for my low back pain?

Back pain is among the most common chronic conditions in Canada. Four out of five adults will experience at least one episode of back pain at some point in their lives.

At our physiotherapy clinics, clients experiencing low back pain often complain that their doctor did not refer them for medical imaging. How could we possibly treat the pain without knowing what’s happening? What if we miss something serious?

The truth is, there are very few situations that warrant immediate medical imaging for low back pain. For most patients, back pain doesn’t involve nerve damage or other complex issues. In fact, the majority of people with low back pain will get better with exercises, over-the-counter pain medication, heat – and time.

Here are a few important reasons why you don’t need medical imaging for low back pain:

Imaging will rarely change the treatment plan.

Research has shown that when it comes to low back pain, it’s best to treat the symptoms not the condition. Regardless of the diagnosis, treatment focuses on stretching tight muscles and strengthening weak ones. With proper body mechanics, back pain improves and can be prevented from happening in the future.

Extensive research has found that medical imaging, such as an x-ray or MRI, rarely diagnose the cause of low back pain. And more often confuse the diagnosis further.  

For example: patient A has no symptoms of back pain but on an MRI has signs of arthritis and degeneration. Studies have shown that signs of degeneration are present in a very high percentage of healthy individuals with no back pain at all.
Patient B has severe low back pain, but on MRI has no signs of degeneration or other injury. In 85-90% of individuals with low back pain, no cause can be identified on medical imaging.1

Nothing is worse for back pain than fear.

Results on medical imaging tests genuinely spook people! It reinforces the idea that something is broken or crooked when there is very little to no relationship between those findings and pain.

It may lead to an unnecessary visit to a surgeon.

The overwhelming majority of patients sent to spine surgeons require specific exercises, physiotherapy, education and a hot or cold pack. General wear-and-tear injuries or aching joints aren't operable conditions, even though they may cause a lot of pain.

So, when would I need an imaging test for my low back pain?

Patients with additional symptoms such as; an inability to urinate, a loss of bowel control, a history of cancer, unexplained weight loss, or fever should speak with their doctor right away. These are a few “red flags” that require prompt medical attention.

Most often, you can skip the scan. Try and start with physiotherapy for low back pain, you might be surprised by the results.