Dave and Rob are with physiotherapist Adam Dobson discussing scans and in particular how MRI scans can and are used in connection with back pain.
Scans are important but only for a small number of patients with back pain and Adam explains in detail the pathway and context that may lead to a scan being done along with reasons why a detailed clinical diagnosis is so important in this episode packed with great information and content.
Its ultimately about the right scan at the right time and this is a great opportunity to find out more.
 
KEY TAKEAWAYS

90% of back problems are not diagnosable on a scan and a scan will only be important for a small number of patients with back-related problems.
Scans can be used to rule something out such as a fracture, cancer or an infection and may open up a change of treatment plan.
If there is a good quality working diagnosis then imaging can create a potential additional step before treatment begins.
Patients should know what a scan is likely to show, the implications of the findings and what it might change.
Scans are highly detailed and show lots of things that may not be relevant and are common in lots of the population. These things are not predictors for pain or function in the future.
Patients should be prepared and educated to help them understand imaging.
If you’ve had a problem for less than 6 weeks, the nerves are working and there are no indicators for serious pathology there is a high chance your problem will resolve itself over time.
It’s about the right scan for the right person at the right time
The picture can change - If you are told you don’t need a scan it doesn’t mean you will never need one.
If you have persistent and disabling pain there is something wrong but it can be about the factors involved and where best to focus effort with therapy and support powerful options.

 
BEST MOMENTS
‘If it’s is unlikely to change the treatment plan and there is no evidence for serious pathology then there is a strong argument that imaging is not required’
‘An MRI scan can be used as a reassurance about what’s not there’
‘In collaborative working with the patient imaging is a malleable decision’
 
VALUABLE RESOURCES
The Back Pain Podcast
The Back Pain Podcast recommended products affiliate link
Adam Twitter https://twitter.com/adamdobson123
What is sciatica booklet https://www.southtees.nhs.uk/content/uploads/ST1112-Sciatica-Booklet.pdf
Handy information guides on back pain, sciatica, Cauda Equina, posture and more.
https://www.southtees.nhs.uk/services/back-pain-triage-and-treat/patient-information-educational-resources/
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173
 
Belavý, D. L., Quittner, M. J., Ridgers, N., Ling, Y., Connell, D., & Rantalainen, T. (2017). Running exercise strengthens the intervertebral disc. Scientific reports, 7, 45975. https://doi.org/10.1038/srep45975
 
Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples P.H. FerreiraP.Beckenkamp C.G. Maher  J.L. Hopper
 
The 'Lived Experience' of patients having a Cervical or Lumbar MRI scan Armitage, Annabelle; Harland, NicholasPain and Rehabilitation - the Journal of Physiotherapy Pain Association, Volume 2020, Number 49, July 2020, pp. 57-62(6) Physiotherapy Pain Association
 
Low back pain and sciatica in over 16s: assessment and management NICE guideline [NG59] Published date: 30 November 2016 Last updated: 22 September 2020
 
NHS website back pain website https://www.southtees.nhs.uk/services/back-pain-triage-and-treat/
National Low Back and Radicular Pain Pathway   https://www.boa.ac.uk/uploads/assets/e26cc007-74c3-4b22-94e408dd54ac79da/spinal%20pathfinder.pdf
 
 
ABOUT THE HOSTS
Dave Elliot
Dave is the owner of Advanced Chiropractic, a chain of Chiropractic and massage therapy clinics in Essex, UK. Dave still