Imaging In Musculoskeletal Medicine… Not All It’s Cracked Up To Be*

Medical imaging comes with a price tag of $100 billion per year in the United States.  MRI use tripled over one decade from 1997-2006 (1).  Does increased imaging usage improve treatment outcomes?

X-Ray

            X-ray images are primarily used to view skeletal anatomy and some soft tissues. This type of imaging is appropriate for viewing fractures, inflammatory arthropathies, infections and certain cancers (2).  An x-ray is not appropriate unless your physician suspects the aforementioned diagnoses.

X-ray images are unable to distinguish intervertebral discs and are incapable of diagnosing herniated or bulging discs.  Evidence indicates routine x-rays for something such as non-specific or acute back pain is not associated with any clinically meaningful benefits (3).  Studies have shown positive x-ray findings in asymptomatic individuals and negative x-ray findings in symptomatic persons (1).

MRI

            MRI is an advanced imaging tool used primarily to view soft tissue injuries (muscles, cartilage, tendons, ligaments, and nerves, etc.).  A majority of back pain does not involve pathological tissue damage and may not express itself on an MRI.  Likewise, patients with extensive soft tissue damage and degeneration on MRI may not experience much pain at all (5).  Few MRI findings are associated with patient symptoms of back pain, nor do they relate to disability or intensity of back pain( 5,6).

Conclusion

            When used appropriately, medical imaging is a very important and useful tool in evaluating patients with acute trauma, infection, history of malignancy, progressive neurologic deficits and when conservative care fails.  However, in most chronic pain situations, imaging does not correlate with clinical symptoms; it may be detrimental to treatment outcomes, and lead to unnecessary and costly medical interventions.  Most people with lower-back pain feel better in a month or two regardless of whether they get an imaging test or not (4).

Key Point – Move often, move better

            MRI and x-ray imaging are limited in viewing how a patient moves.  In manual therapy it is incredibly important to evaluate and recognize dysfunctional movement.  Moving correctly, with appropriate muscle sequencing and strength will improve pain without taking an expensive diagnostic image.

-TJ Peterson, ART,DC

*Chiropractic pun intended.

 

References

1.      Smith-Bindman et al. Rising Use Of Diagnostic Medical Imaging In A Large Integrated Health System. Health Aff (Millwood). 2008 ; 27(6): 1491–1502.

2.      van Tulder et al. Spinal Radiographic Findings and Nonspecific Low Back Pain. Spine. 1997 ; 22(4):427-434.

3.      Chou et al. Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Ann Intern Med. 2011;154:181-189.

4.      Consumer Reports. Imaging tests for lower-back pain. American Acadamy of Family Physicians. 2012

5.      Berg et al. Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis.  Skeletal Radiol. 2013; 42:1593-1602.

6.      Sure et al. Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK). BMC Musculoskeletal Disorders. 2014; 15:152

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