There’s something wrong with this picture…

One thought that always seems to come up when people have back pain is the question about getting imaging.  Whether it’s an MRI, Xray, or CAT scan, most people are at least curious as to why they didn’t get some sort of imaging.  I mean, they blew out their back!  Who wouldn’t want to know what’s going on in there?

It turns out, getting imaging done for back pain in general isn’t all that helpful unless you have certain symptoms (sudden changes to bowel/bladder function, worsening weakness/numbness in the legs, and changes in motor control to name a few).  Notice those symptoms are related to the function of your spinal cord.  Back pain, severe or not, is still a concern.  However, imaging is usually done to rule out a fracture in the case of direct trauma or to rule out involvement of the spinal cord.  If there isn’t suspicion of those things, typically you’ll get a referral for physical therapy for at least one month.

That should tell you something.  Even if there are concerns over a slipped disc or arthritis or degenerative change, the treatment with the best evidence for improving back pain is physical therapy.  In other words, the best treatment is to move.  With guidance, of course.

But what’s the harm in imaging, even just to make sure?  As mentioned in the linked article above, imaging can actually CAUSE more issues with recovery from low back pain.  Ignore the concerns with radiation exposure, and consider the mind.  People tend to be affected by labels, and being told you have something like a spondylolisthesis is sure to cause some sense of fear or anxiety related to your pain.

Perhaps what’s most interesting is that findings on imaging don’t even have a strong correlation to back pain.  If anything, assuming that findings on imaging for your back actually relate to your symptoms is problematic.

That’s not to suggest something like a herniated disc can’t cause pain, but just because it’s on an MRI doesn’t mean it’s causing the pain you’re having.  Findings on imaging are actually normal as we age.  That article from WebMD has a statistic saying that 90% of people over 60 have a bulging or herniated disc… but not everyone over 60 has back pain (and many of them never will).  Think of findings on imaging as wrinkles – they may not look pretty, but they don’t necessarily hurt anything.

If you have concerns over your back pain, don’t think that getting an MRI or X Ray or CAT Scan is going to answer your problems.  There are definitely times when imaging is the first choice, but those instances are rare.

If you’re having a hard time dealing with your back pain, consider a physical therapist first.  They are trained to address the actual cause of pain and get you moving better.

Got questions?  Feel limited in what you’re able to do?  The staff at Limitless Physical Therapy in Eugene, OR can show you how to be limitless. Contact us to connect with on of our PTs. Or follow us on Facebook.


  1. Chou R, Qaseem A, Owens DK, Shekelle P, . Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Ann Intern Med. 2011;154:181–189. doi: 10.7326/0003-4819-154-3-201102010-00008
  2. Hong JH, Lee MY, Jung SW, Lee SY. Does spinal stenosis correlate with MRI findings and pain, psychologic factor and quality of life? Korean J Anesthesiol. 2015 Oct;68(5):481-7. doi: 10.4097/kjae.2015.68.5.481. Epub 2015 Sep 30. PubMed PMID: 26495059; PubMed Central PMCID: PMC4610928.
  3. Mann, D.  Skip the MRI for Low Back Pain?  WebMD.  31 Jan 2011.  Available at  Accessed 18 Jan 2018.

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