Low Back Pain: When Are Imaging Tests Actually Helpful?

When experiencing low back pain, it’s common to think that imaging tests like X-rays, CT scans, or MRIs would provide clear answers and a direct path to treatment. While these tests can be useful in certain situations, they often aren’t as beneficial for most cases of low back pain as you might think.

Imaging Tests Do Not Speed Up Recovery

Most people with new low back pain feel better after four weeks, regardless of whether they undergo imaging tests. In fact, research has shown that patients who receive an MRI early on don’t recover faster than those who don’t. A study involving 1,800 patients with low back pain found that those who had an MRI soon after the onset of pain were no better off at the four-week mark compared to those who didn’t. The most effective way to speed recovery is by following proven treatments, such as chiropractic care, physical therapy, and exercise, not by relying on imaging tests.

Imaging Tests Can Actually Make Things Worse

Interestingly, imaging tests can sometimes lead to unnecessary treatments, including surgery. One study revealed that people who had an MRI within the first month of back pain were 8 times more likely to undergo spine surgery. These patients also accumulated five times more medical expenses, but they didn’t recover any faster than those who didn’t undergo the scan. This is often due to false positives: imaging tests frequently reveal abnormalities, such as disc degeneration or arthritis, that are unrelated to the pain the patient is experiencing.

For example, 40% of people under 30 have MRI findings of disc degeneration or arthritis, even without any pain. By the age of 50, over 90% of individuals show signs of disc degeneration. So, when an MRI reveals these normal aging changes, it’s easy for doctors to attribute the pain to those findings, even though they may not be the cause. This can lead to unnecessary treatments, such as surgery, rather than addressing the actual cause—movement dysfunction and poor spinal mechanics.

When Are Imaging Tests Really Necessary?

While most back pain does not require imaging, certain situations call for tests. If a doctor suspects a more serious underlying issue, like cancer, infection, or severe nerve damage, imaging tests are necessary for accurate diagnosis. People who have certain red flags, such as unexplained weight loss, fever, history of cancer, loss of bowel or bladder control, or abnormal neurological symptoms, may need imaging to rule out dangerous conditions.

For the vast majority of patients, low back pain is a result of mechanical issues, such as poor posture, muscle strain, or a sedentary lifestyle, which can often be treated without imaging. However, imaging can be crucial in detecting and diagnosing issues that require more intensive medical interventions.

For most individuals with low back pain, imaging tests may not be needed immediately. They can often lead to unnecessary treatments and don’t speed up the healing process. Focusing on treatments like chiropractic care, physical therapy, and regular exercise has proven to be the most effective way to alleviate pain and prevent future episodes. If there’s concern about a serious condition, your doctor will consider the appropriate use of imaging to make the right diagnosis and guide your treatment plan.

Always consult with your healthcare provider to understand whether imaging tests are truly necessary for your specific case and to develop the best treatment strategy for your recovery.

Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007 Oct;147(7):478-491.

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