Do I need an X-ray or MRI?

Do I really need an X-ray or MRI?

Often when there is pain in your body, your first instinct may be that something very wrong is going on. That is when you seek out help of a doctor, and often and MRI or X-ray is prescribed for further diagnostic purposes. But is it really neccessary? Not only can they be expensive, an X-ray exposes you to radiation and in the case of something like back pain, often nothing can be seen on either image.

So what is an MRI?

Magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of almost any part of the body, including the brain and spinal cord, bones and joints, muscle, heart and blood vessels and internal organs. Healthy tissue sends back a slightly different signal than ‘problematic’ tissue and this is where diagnosis is made. There is no radiation involved as with x-rays. MRI scans are frequently used to diagnose bone and joint problems, however there may be a problem with the tissue or joint that cannot be seen on the MRI, but can easily be tested for by simple physical tests. This is where your physiotherapist comes in and is often the first person to offer a diagnosis without the use of MRI or x-ray. These tests are more sensitive to what we call musculoskeletal conditions such as neck pain, muscle strains and sciatica. Always keep in mind that MRI does not offer a better diagnosis or lead to better treatment outcomes for other types of back pain.

If there are any signs that you need an MRI then your physiotherapist will know when to refer you on. The good news is that if you do need an MRI, it is a painless and safe procedure and extensive research shows no evidence that an MRI poses a risk to the human body. Just keep in mind you may find it uncomfortable if you have a fear of enclosed spaces, but most people find this manageable with support from the radiographer.

What is an X-ray?

X-rays are a type of electromagnetic radiation, just like visible light which sends individual x-ray particles through the body. The images are recorded on a computer or film. To give you a pretty good idea of what you are looking at in your x-ray:

  • Structures that are dense (such as bone) will block most of the x-ray particles, and will appear white
  • Metal will also appear white
  • Structures containing air will be black, and muscle, fat, and fluid will appear as shades of gray

X-rays are typically used to diagnose and assess bone degeneration or disease, fractures and dislocations, infections, or tumors. X-rays produce detailed images of the bones of the spine but the soft tissues, including discs, ligaments, nerves and muscles don’t show up well on x-ray images. Often an x-ray is not helpful in diagnosing a musculoskeletal condition, but can help show scoliosis or can help rule out fracture in cases that are not healing well.

So what is the conclusion?

Most common sources of back pain (and other musculoskeletal pain), such as muscle spasms, strains and minor inflammation, do not require medical imaging for a diagnosis and can be diagnosed with physical testing by your physiotherapist. In fact it has been shown that after seeing something abnormal on an X-ray or MRI, the psychological impact can actually hinder your recovery, such as in the case of a disc herniation. Statistics show that about 30% of people above 30 without pain have some degree of disc prolapse- so the correlation between seeing a prolapse on an X-ray or MRI doesn’t mean much in terms of your source of pain.

Keep all of the above in mind before opting for further imaging next time you are in pain. Remember to always check with your doctor or physiotherapist before making a decision of course. Coming by to your local Physio Savvy branch and getting an opinion will help you in your first steps to recovery.

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Parisa Tanoori

Parisa Tanoori

Physiotherapist at Physio Savvy
Parisa is certified with a Bachelor of Science in Physiotherapy from Shiraz University of Medical Science, Iran. She is currently completing her PhD in Sports Medicine with the special interest of Kinesiology taping in Universiti Malaya.
Parisa Tanoori

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Posted in Musculoskeletal Disorders.