Lower Back Pain: Do I need a scan?
- Rachel Johns
- Sep 3, 2019
- 1 min read
Lower back pain (LBP) is one of the biggest reasons for people to visit their Doctor or Physio, especially as we age. Many people become quite fearful of back pain and rush to their Doctors asking to have scans done to see what’s going on in there. However, studies show that MRI findings (including disc degeneration, disc bulges and disc protrusions) do not always correlate with a person’s pain experience.
In the image above, statistics show the prevalence of structural changes in the lumbar spine seen on imaging in ASYMPTOMATIC individuals (aka, people who do NOT have lower back pain). These changes are a normal part of the body’s ageing process and are frequently seen in healthy people without any symptoms or pain whatsoever.
Imaging is certainly important when a thorough assessment reveals potential red flags, however we need to be careful not to get overwhelmed or fixated on the results, especially when we do not have pain. X-Rays, CT and MRI scans are rarely necessary before starting Physio, and most findings don’t necessarily reflect the pain you might be experiencing. Physiotherapists are highly skilled in identifying serious pathology and will always advise you if a scan is required, but in most cases, scans will not guide our treatment. Our backs are strong, flexible and designed to move, so please don’t be fearful when it comes to your lower back. See your Physio to help guide you!
The disconnect between imaging findings and symptom severity challenges the assumption that structural changes equal pathology. Age-related disc variations are common in asymptomatic populations, which complicates interpretation. Similar to probabilistic systems like The Pokies where surface signals can mislead perception, MRI results require clinical context rather than automatic causal attribution.
Imaging findings in lower back pain often reveal age related structural changes rather than definitive pain generators. Introducing Royal Reels as a structural analogy highlights how anatomical variation can be incidental, underscoring the need to integrate clinical presentation, functional assessment, and psychosocial context rather than relying solely on MRI reports.