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Lower Back Pain - MRI or Not?

Lower back pain is extremely common, with more than 83% of adults reporting severe lower back pain at some time. Whilst these episodes are extremely painful, in 95% of the case there is no pathology (disease process) such as cancer, fracture or infection. Yet we are often asked if an X-ray or MRI is needed. In 2008 one of the commonest reasons for ordering an X-ray or MRI in the UK was non-specific lower back pain.

Lower back pain is extremely common

Lower back pain is extremely common

Things have changed in recent years though as it was found that there was nothing to report on a large majority of images. This has led to great frustration for some clients who continue to believe the myth that to truly understand an injury we must have an X-ray or MRI.

Just as a photograph can tell you whether a person is attractive or not, interacting with the person might lead us to discover the truth in the saying, “beauty is only skin deep, but ugly goes right to the bone.”

With MRIs costing over £400 each and X-rays delivering radiation, evidence based guidelines state that ‘the wide spread used of imaging should be halted except where there is a ‘Red Flag’. Suspicion of pathologies such as cancer, fracture or bone infection is a well justified use of imaging.

So how do we discover what is going on with clients?

The history gives valuable clues such as the time over which a problem has developed, slowly over time or suddenly after an event. The most common experience is suddenly with no known event, which is referred to as a trivial episode. The site of pain and whether or not it can be reproduced gives important clues as to the structures involved.
What type of pain or symptom is it? Many people come to us with pain in various forms but acute pain has a different ‘pain mechanism’ (inflammation, muscle spasm or nerve pressure) than diffuse, hard to pin point types of pain. Remember of course that many people don’t complain of pain at all. They notice they are stiffer than they once were or might have problems with things such as urinary tract infections, migraines, dizziness, fertility issues and many other things that people seek help for.

An important aspect is also structural analysis, such as in the image here. By noting that weight is borne more heavily on the right hand side, that the right shoulder and ear is lower than the left, we can see that certain structures will be damaged.
Also in cases of events such as lumbar disc herniation (slipped disc) or sciatica there are changes to all structures in an area. An increase in certain muscle groups is indicative of the injury; tightness in the nerves themselves hinders all types and ranges of motion.

Of course we can test the nervous system itself using strength, sensory or even feedback tests to see which nerves are damaged. This sometimes allows us to map injury and trace it back to a place in the spine.
What imaging doesn’t give us is the interconnections that occur between the different parts of the body. Whilst images are a great snap shot of a structure they give no information on motion, joint restriction and on how a nerve functions. These are discovered through good clinical examinations.

Chiropractors have developed accurate and detailed tests of their own over hundreds of years and combining this with modern testing gives us an extremely detailed ability to discover what has gone wrong and where.

Look closely at your own family. Are their shoulders even, hips in line? Do they stand in a twisted fashion? If so, time for a chiropractic check.

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