I NEED Imaging For My Back!
We go to bat for you, but…
If any of you reading this know our team in any capacity, you know we are all for you, our client. Advocacy for our clients’ needs is our game and we are happy to go to bat for you. But when it comes to lumbar imaging, we do take some pause.
We don’t hold back a second just to torture you. We don’t hold back to deny you a label for your pain or symptoms. We don’t hold back because we’re not on your side. We hold back because sometimes you just don’t actually need imaging for your back.
Lumbar imaging doesn’t improve the care
In 2012, the Ontario government withdrew public insurance coverage of imaging tests for uncomplicated low back pain because there was a trend that these were being ordered despite evidence that they do not improve the quality of care or outcomes in many settings. The Ontario government would only allow payment for X-rays, CT scans, and MRIs of the lumbar spine when rendered for low back pain with suspected or known pathology. This would include what we call ‘red flag’ type of things such as infection, tumor, osteoporosis, ankylosing spondylitis, fracture, inflammatory process, radicular syndrome and cauda equine syndrome.
What are we going to do with the information?
Before you pick up the phone to give us a piece of your mind, just hear us out. Let’s say you have ‘uncomplicated’ back pain by definition (we’re not a monster; we can empathize that if you have had back pain, it’s no joke, and it definitely does not feel ‘uncomplicated’), and you get an X-Ray or CT-scan, or maybe even you got an MRI, what the heck are you going to do with that information?? But seriously, give it some thought. It’s a legitimate question to consider. Besides giving you a label (more on that in the next paragraph), how is that information going to influence decision making moving forward? Are you planning for a surgery?
The image doesn’t tell the whole, or even a good chunk of the story
If you are wanting imaging because you just want to get better, your best bet is actually to make yourself an appointment with a physiotherapist. Physiotherapists have a detailed understanding of all the ways your back can hurt and they can actually help you and your back feel better. The act of getting an image done of your back does not get you better. That’s a plain and simple fact.
Imaging for ‘uncomplicated’ low back pain can slow progress
Generally speaking, as people, we like labels. We seem to understand things better when we can categorize them that way. And we can totally empathize. But, did you know that when we jump the gun at imaging for your back you are actually setting yourself up for delayed progress? A study by Flynn, Smith, and Chou in 2011 concluded that “overutilization of lumbar imaging in individuals with low back pain correlates with, and likely contributes to a two-to three-fold increase in surgical rates over the last ten years. Furthermore, a patient’s knowledge of imaging abnormalities can actually decrease self-perception of health and may lead to fear avoidance and catastrophizing behaviours that may predispose” individuals to chronic pain and persisting disability. Have you also considered the scenario of incidental findings? When we go looking for something, we are bound to find something. But, that doesn’t mean what we find actually correlates in any way to what you are feeling: that is exactly what an incidental finding is. Can you imagine, in your state of vulnerability, getting a report back with all those scary words? When you are already wore down and frustrated because of pain, you get in your head because of all the things wrong with your back from that report. How can you possibly get better when you are doomed? Imaging reports have that much power. The point that is trying to be made here is that sometimes a label (or an image) can’t correctly identify your symptoms and provide the necessary information to correct your back pain.
Physiotherapy for low back pain can help
You know who can? Your physiotherapist (wink wink)! Your physiotherapist, even without X-Ray vision, can perform a comprehensive assessment that will provide far more meaningful information about what is going on with your back and how to get you better than any machine out there. Working with your physiotherapist and making a reasonable effort with respect to exercise, activity modification, stress management, sleep hygiene, nutrition among other things should get you the results you need to get back to your life. And in the chance it doesn’t, we will advocate for you to get what you need outside of physiotherapy. We promise.
Contributed by Corey Ireland, Registered Physiotherapist and Pelvic Health Therapist
References
Fine B, Schultz S, White L and Henry D. Impact of restricting diagnostic imaging reimbursement for uncomplicated low back pain in Ontario: a population-based interrupted time series analysis. CMAJ Open. 2017; 5(4): 760-67.
Flynn T, Smith B and Chou R. 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: 838-46.