Do I need a scan? A Physiotherapists view

An X-ray, MRI, CT, ultrasound, PET scan, bone scan and DEXA are all types of scans or imaging as they are collectively known. A question I often hear from patients is “do I need a scan?” and the honest answer is, it depends. To help answer this question I have put four scenarios below of when imaging is appropriate or required, when it isn’t and why.

Scenario 1

I’m 26 years old and a keen runner. Two days ago, whilst out for a run on uneven ground I twisted my ankle and fell over. At the time I heard a sound, my ankle was really painful, and I struggled to walk or put weight on it. Shortly after my ankle became swollen and was slightly bruised. Do I need a scan?

Answer

Highly likely! For this instance, if there was an audible sound accompanied with pain and swelling and you were struggling to weight bear immediately after, it is possible that there might be a fracture so an X-ray would be helpful to identify this as it will impact management. Once we have the imaging results then a Physiotherapist would be able to help this patient with their recovery and goals.

Scenario 2

I’m 45 years old and enjoy going on long walks and hikes at the weekends. I’ve been experiencing lower back pain for the last 4 weeks. Gradually my pain has been getting better and gentle exercise helps ease my symptoms, especially when I flex my spine or bring my knees into my chest, but my pain hasn’t completely gone away. My back pain worsens when I stand doing household tasks for more than 15 minutes or if I have to walk more than an hour. Do I need scan?

Answer

No. Imaging for low back pain is only recommended when there is a suspected serious condition. Imaging low back pain that appears mechanical in nature (meaning there are movements or activities that ease and there are movements or activities that aggravate) is not recommended. This is because this type of low back pain usually settles within 3 months and evidence shows that early unwarranted MRI scans are associated with higher intervention rates and poorer outcomes. Imaging is just that, it can only provide an image, it cannot tell us how someone is feeling and it is not a diagnosis. Furthermore, evidence found that in patients who have no pain MRI reports found 91% of them had disc degeneration and 64% had a disc bulge and these findings increase with increasing age and are signs of a naturally maturing spine. So in this instance, imaging is not required and would be unhelpful to this patient’s recovery. Instead this patient should come and see a Physiotherapist who will be able to help them with their recovery.

Scenario 3

I’m 60 years old and I used to play tennis and go to the gym regularly last year but I have been unable to do either of these for most of this year because of work and life commitments. 3 months ago, I got back into my tennis and gym routine and noticed my right knee start to become painful especially after a tennis match, but after a day or two of rest it improved. Over the past 2 weeks the pain has gotten worse, my knee appears swollen and I can only manage 20 minutes of tennis. If I rest for a couple of days the pain still settles but the swelling doesn’t appear to be improving. Do I need a scan?

Answer

No. When symptoms have a gradual onset without any trauma, such as a fall, can be aggravated with increased loading, like playing tennis, and then eased with relative rest, it is highly unlikely that imaging is needed. Instead, the best course of action would be to come and see a Physiotherapist who will be able to conduct a full thorough assessment, identify the cause, implement a treatment and management plan to help this patient return to their goals.

Scenario 4

I am 73 years old and last year I was told I have osteoporosis. I am an avid gardener and over the last year I have been trying to increase my physical activity as advised by my Physiotherapist and GP. I have been doing really well and then last week I was in a rush, and I slipped stepping off a kerb and landed on the side of my right hip. I felt some pain at the time, but I was able to get up and keep going about my day. Since then, it has felt quite painful, especially when I’m sitting and it can bother me at night time. There’s nothing that seems to help it feel better. Do I need a scan?

Answer

Yes. As this patient has osteoporosis, which means that they have reduced bone density, and because they had a small fall it is important to identify if there is a fracture or not as this will impact management. Once we have the imaging results then a Physiotherapist would be able to help this patient with their recovery and goals.

I hope these scenarios provided further insight as to when imaging is needed and when it is not. If you’re still not sure, do come in and see one of our specialist Physiotherapists and they will be able to help you.

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