Q: I had X-rays taken of my low back and wish I never knew what I know now. The X-rays showed severe arthritic degeneration and severe stenosis. Suddenly, I started feeling much worse. It didn't change the treatment plan so what's the point?
A: You make a very good point and one that is backed up in research. Studies show that findings of degenerative disease, malalignment of the spine, and other anatomic problems or deformities don't always cause symptoms. And the opposite is true, too -- patients with severe pain may have very normal looking X-ray, CT scan, or MRI results. Successful, evidence-based treatment may not depend on imaging results.
In fact, sometimes like you, patients who see the changes on imaging studies (or who are told about them) end up worse off. Their perception of health deteriorates. They start avoiding certain activities or movements that "might cause pain." The end-result is worse pain and decreased function. Not only that but the rates of surgery have increased two to three times what they were 10 years ago.
X-rays and other imaging studies have their place. But experts advise everyone (patients, primary care physicians, surgeons, physiotherapists) that whatever imaging studies show, this is a snapshot at a single moment of time. And it's a fact that many, many people with back pain and "positive" X-rays showing disc or other spine degeneration recover fully from their painful symptoms even when the X-ray doesn't change.
Future studies will continue to provide information that will help people with low back pain understand the role of self-care, get the right kind of treatment when needed, and save money in the process. Staying active, engaging in movement of all kinds, stretching, and maintaining flexibility are all valuable ways to maintain good spine health and an active, pain free lifestyle. And this approach can be followed successfully without the need for X-rays in most cases.
Reference: Timothy W. Flynn, PT, PhD, et al. Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder That Unnecessary Imaging May Do As Much Harm As Good. In The Journal of Orthopaedic and Sports Physical Therapy. November 2011. Vol. 41. No. 11. Pp. 838-846.
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