I am always interested to read articles, postings and blogs by Dr. Tim Flynn PT, PhD. His take on various topics in the realm of physical therapy are always fascinating to me, and to witness him lecture and teach in person is even more of a pleasure.

One of the subjects he is passionate about is the over-use of imaging related to musculoskeletal conditions, and the spine in particular. As I was scanning PT nerd reading I came across another one of his commentaries on this subject (see link here for full posting http://www.evidenceinmotion.com/blog/2016/04/27/the-power-of-images/).

In brief, his point is just as changes in the body happen on the outside that we can see, so do changes happen on the inside to the body’s joints and spine. What we often see on imaging are normal age-related changes, yet they are framed to the patient (based on imaging- MRIs, CT scans, Xrays) in a negative light. For example…looks like you have a bulging disc there. Yep, so do nearly 60% of folks over the age of 60. And another nearly 40% showed evidence of a “herniated disc”. And you know what percentage of those individuals had pain??????….none!!!! as this report(1) was on asymptomatic individuals. So the bottom line is, just because something may or may not be noted on advanced imaging does not necessarily mean you will have pain or reduced function.

What I have seen in practice is, those individuals who truly believe the cause and effect relationship between age changes and pain are the ones more likely to allow themselves to be debilitated by it. Numerous studies (2-3) report significantly higher medical costs (we are talking thousands of dollars here) for those with advanced imaging of the spine within 1 year.

So what should you think?…as one of my mentors put it, “do not worry about what you cannot change (pathology or age changes), focus on how you can improve the environment in which those changes live to improve patient function”…or something to that effect. What I am saying is, while imaging is great for life threatening issues, it is not the be all end all for the majority of musculoskeletal issues that fall within the realm of physical therapy. Do not let imaging findings impair your function, seek the assistance of a PT to get you back on track.

1. Boden et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J. Bone Joint Surg. Am. 1990;72:403-408.
2. Fritz et al. Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges. Health Research and Educational Trust DOI: 10.1111/1475-6773.12301
3. Flynn et al. Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do as Much Harm as Good. J Orthop Sports Phys Ther 2011;41(11):838-846