'TREAT THE MAN, NOT THE SCAN'

As Musculoskeletal Physios, we regularly meet people narrating their story of pain because their scans told them that they have a ‘L4-5, L5-S1 disc bulge’ or that it is ‘bone on bone in the knee’ or ‘bursa pinching in the shoulder’ etc. For some people, it could be true and quite clinically relevant to their history of pain and its progression but in the vast majority, it is considered NORMAL or even AGE-APPROPRIATE ‘radiological findings’. The first thing we need to remember is: A scan DOES NOT pick up/ find/ diagnose Pain.


Often MRIs/ CT scans/ ultrasound findings can unfortunately add an information overload to the person in Pain and result in more harm than good. It creates a self-image of being ‘damaged’ which may absolutely not be the case. The fear of causing more harm results in the person limiting normal movements and every enjoyable physical activity they once loved. Moreover, simple day-to-day movements such as sit-to-stand, bending forward, lifting, squatting, getting up and down from the floor etc becomes a threat and we often see them lost or modified due to the presence of discomfort during the movement. This is the result of what research calls fear-avoidance and Kinesiophobia (fear of movement). These behaviours are unhelpful in the journey to recovery and often lead to persistence of symptoms whilst results in long-term deconditioning and poor fitness.


Here is the illustration from some recent research studies showing ‘abnormal findings’ on scans in active normal population with ’no pain’.
1. 87% of people without back pain have disc bulges
2. 72% had a Labral tear (SLAP tear) in the shoulder
3. Nearly 50% had knee meniscal changes
4. 69% had a Labral tear in the hip

Basically, we are all going to change as our age advances and just the way we develop greys in the hair which is non-painful process, our joints also start to grey and wrinkle from the inside.


Abnormal or just part of life

Let’s consider this scenario: You have a ‘disc bulge’ and you don’t know about it. This process must have commenced since you were in your 20’s but you have no pain whatsoever. You played soccer in your younger days, then life got busier and you found a desk-bound job. All your activities curtailed and you have adopted a very sedentary lifestyle. Suddenly, one day you bent forward to pick up a pen from the floor and you sensed a sharp catching pain in your back. The pain lasted for more than a week and you get an MRI, and they find the ‘disc bulge’! This bulge which was part of your normal anatomy for decades is now the source of your pain? Possible but very unlikely (due to the odds). Will you stop bending forward forever because it hurts? Does surgery have a role in the Pain and when? How can we make sense of this dilemma? Is it likely the deconditioning of the individual and their movement behaviours played some role? All these are questions worth asking your Physiotherapist .


In summary, it is important to remember that scans do not always correlate to an individual’s pain. Its relevance needs to be substantiated with a good history-taking and clinical assessment to establish any diagnoses, establish if its ‘safe to move’.


So, keep active as MOTION IS LOTION and if you are finding any difficulties getting up and about, call your physiotherapist who treats you and not your scan!


Get in touch with us at Praxis Rehab Physiotherapy for a chat or book online at https://www.praxisrehab.physio if you have any injury limiting you from moving.


References:
Nakashima, H et al. Spine (Phila Pa 1976), 2015.
Brinjikji, W. et al. Am J Neuroradiol, 2014.
Beattie, K.A. et al. Osteoarthritis Cartilage, 2005.
Schwarzburg, R. et al. Orthop J Sports Med, 2016.
Register, B. et al. Am J Sports Med, 2012.

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