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Should I get an MRI or X-ray for my lower back pain?

April 24, 2017

The short answer, probably not! Why?  You say? Because the evidence is stacking up that MRI and X-ray are very unreliable at providing information that will alter therapy in a meaningful way. What I mean by this is, the vast majority of studies that look at the validity of MRI and X-ray have shown that a lot of the more significant findings, such as disc protrusions, scoliosis and arthritis, are present in a vast number of people who do not have any symptoms of lower back pain at all. This begs the question, if those structures are being blamed for somebody’s pain, then why does that other person with the exact same findings on MRI or X-ray not experience any pain or problem?

The latest guidelines for physicians from the American College of Physicians ( and NICE ( strongly recommend against routine referral for imaging for people with acute lower back pain. The consensus is that imaging is only necessary when there is severe and/or worsening neurological deficit (i.e. symptoms of nerve compression such as weakness, sensation and/or reflex change in the arms and/or legs) or suspicion of a pathology such as bone tumour or spinal fracture which will require vastly different management.

For those with lower back pain and/or sciatica (i.e. pain in the buttocks and/or legs) without suspicion of significant pathology, MRI and X-ray is not going to provide information that will change management. You may think though, why not do it just in case? The reason is, once someone with low back pain is made aware of all the physical changes in their lower back that may or may not have anything to do with their pain, it can invoke a sense of fear and a feeling of fragility with regards to the spine. This often hinders recovery by increasing stress, reducing participation with work and exercise, and changing movement and muscle patterns (i.e. one can get very protective of their spine).

The take home message is; if you have acute lower back pain the current best management is to remain active, use non-steroidal anti-inflammatories and consult a physiotherapist for prescription of a home exercise program that will assist in the speedy restoration of movement and reduction of pain. Don’t rush into scans! If you have lower back pain, come see one of our highly trained physiotherapists at Focus Physiotherapy for an expert assessment.  If scans are necessary, then we will gladly refer you on, but 9 times out of 10 we can manage your condition without them!

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