Can I just get a scan?

I am asked this question quite often and I totally understand. It is likely that you have:

-          been in pain for a long time

-          had quite debilitating episodes of pain

-          seen several health professionals and had a mixture of diagnoses

-          feel exasperated, frustrated, and worried

You want answers, and feel like a scan will give you those, and it might, BUT it’s worth knowing some of the following information to enable you to better understand what a scan may show and why this may not be helpful.

“Studies have found people WITHOUT pain have tissue damage. Including disc protrusion, prolapse & bulges, knee menisci frayed, and tendons thickened.
All without pain. ”

An MRI (most common scan used for muscular/soft tissue structures) is not a complete photograph of the inside of the body, complete with a flag showing the source of pain! A scanner will take images in slices through a specific cross-section of what is thought to be the injured structure. Therefore, it is important that an assessment has taken place, by a qualified practitioner, to ascertain which structures should be scanned. A GP will not be able to accurately make this diagnosis.

Once a scan is done, a report will be generated, complete with all the findings - if you’re over the age of 30 there will likely be a lot of findings! A consultant or practitioner will need to identify what, from all the findings, is relevant and a likely source of pain.

This is the tricky part….

Studies have found people WITHOUT pain have tissue damage (1). Including disc protrusion, prolapse & bulges, knee menisci frayed, and tendons thickened (2). All without pain.

“Why? Perhaps because some of these changes are a normal part of aging, a bit like wrinkles. ”

So, how do we know which are causing your pain and which are normal for you? In some cases we don’t, and studies have shown that intervention based off early scans can lead to worse outcomes (3).

Pain that has lasted more than 3 months will have evolved in nature. It is often less about tissue damage & more about the complex relationship between your body & brain. The pain will be fuelled by stress, pressures of returning to work, it may be triggered by movements you deem to be dangerous.

None of this can be located on a scan. And it is for this reason, in the absence of any red flags (symptoms that suggest a more concerning pathology), that I advise conservative management for a period before delving into the world of scans.  

It is also worth asking yourself the following questions:

-          Am I willing to have surgery if a scan indicates this may be helpful? If not, then what are you hoping to gain?

-          Have I diligently completed my rehab plan to this point?

-          What rehab will I need to do after surgery? Am I likely to stick to post-op rehab? (see above point!)

 Only once these points have been discussed & addressed, a scan may then be recommended.

If you’re feeling at a loss with a long-term injury, give me a call or complete my contact form to chat about your condition.

1. Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA. The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) 2001 May 15;26(10):1158-66.

2. Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine (Phila Pa 1976). 2015 Mar 15;40(6):392-8

3. Sajid IM, Parkunan A, Frost K. Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care BMJ Open Quality 2021;10:e001287