The illusion of medical imaging: why a bad scan may not be as bad as you think, from our Registered Osteopath, Clinical Pilates Instructor and Strength & Conditioning Coach Andrew Hudson.
I am often asked if I think an MRI scan in necessary and my answer is most often no.
Let’s take back pain as an example - it is estimated that only 1-5% of back pain is caused by a serious medical condition that could be detected by an MRI. So, for approximately 95% of people with back pain, an MRI is a costly and unnecessary procedure. This is because most people’s pain is not caused by an underlying disease or injured structures.
However, MRI scans can provide a lot of reassurance. By way of exclusion, they can provide peace of mind pain that an individual's back pain does not have a more sinister cause. Yet when taken out of context, the results from these scans can actually increase anxiety. Many people who have had scans in the past tell me they have “bulging discs and arthritis”, which leads to them avoiding perfectly safe movements or activities they love in order to protect their backs.
It is important to note that disc bulges are very common in people with no pain. A 2015 study showed that 29% of 20-year olds had disc bulges but no pain, and 37% of the same pain-free group also had arthritic change. By 80 years old, 48% of people had disc bulges with no pain.
These findings challenge the assumption that pain is due to age or “wear and tear”. MRI scans don’t show pain. Pain is far more complex than we previously thought, and is not simply the result of damage or ageing, hence why MRI scans are often not the answer to diagnosing your pain.
But it’s not just our backs that are affected. In 2006 the Royal College of Surgeons found that even in people with no shoulder pain, 11% had full-thickness rotator cuff tears and 38% had some degree of damage. These people would never have known that there was anything ‘wrong’ if they hadn’t had a scan. Being told you have a full-thickness rotator cuff tear in your shoulder could cause a level of anxiety and possibly impact your quality of life - fear and anxiety has been shown to increase pain.
Even athletes with peak physical fitness show ‘worrying’ MRI findings despite being pain free: 77% of college hockey players had hip problems according to their MRI results, and an entire basketball team had knee problems (Papas et al., 2016; Brinjik et al., 2015). Yet these are young people living active, pain-free lives.
From this research, it is reasonable to see some element of structural damage as a normal part of life. This is not necessarily linked to pain or function. If a scan has shown a problem, that doesn’t always mean that it is causing pain, so don’t avoid movements unless you’ve been advised to. Lack of movement will increase pain and lead to the loss of strength and flexibility.
Our bodies are strong and resilient and respond well to exercise and movement. If you try worrying less and moving more, you may be pleasantly surprised by just how much a difference this can make to both your quality of life and any pain you may be experiencing.
If you are worried about any scan results, or are unsure what they mean, please contact us and we can talk through the findings with you.
Andrew Hudson
Registered Osteopath, Clinical Pilates Instructor and Strength & Conditioning Coach
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