The Pitfalls of Diagnostic Reports

Are you concerned about your Xray or MRI findings? They may not be worth the worry and stress! Medical imaging such as Xrays, ultrasounds, MRIs and CT scans can be very useful and valuable for identifying serious conditions.  However, once serious conditions, such as fractures and tumors, have been ruled out, the majority of findings on these reports may not be abnormal and may not be the cause of your pain.

Bahram Jam, a physiotherapist and founder of Advanced Physical Therapy Education Institute, has summarized information on this topic. He calls this misleading information: “VOMIT – Victims of Medical Imaging Technology”!  He has found studies that support findings that these diagnostic tools may be harmful from a psychological point of view.  These studies have shown that “those who are told of “abnormal” (though irrelevant) findings on their medical imaging have more doctors’ visits, longer lasting pain, more disability, and a lower sense of well-being.”

What are these tests showing? Commonly these diagnostic reports diagnose patients with disc bulges, degenerative joints and arthritic changes. While this may be true, these types of changes in the body are not “abnormal” and may not be the true source of what is causing pain, muscle imbalances and biomechanical changes.

For example, in the lumbar spine, studies have shown that disc degeneration is present in 40% of individuals under the age of 30 and is present in 90% of those between the ages of 50-55 years.  “Leading physicians at the department of Neurosurgery at the University of California strongly recommend against routine use of MRI for low back pain since they have found NO LINK between degenerative changes seen on Xray or MRIs and low back pain.”

In the hip, studies have shown a weak association between joint space narrowing and actual symptoms.  One study showed that “77% of healthy hockey players who had no pain, had hip and groin abnormalities on MRI”.  In the neck, an MRI study of healthy adults found that 98% of all the men and women with no neck pain had evidence of degenerative changes in their cervical spine.  What this is saying, is that the majority of all healthy adults get neck degeneration (osteoarthritis) and disc bulges. This is a normal aging process!  Bahram Jam summarizes this concept and states “neck arthritis or mild to moderate disc bulges cannot possibly be a reasonable explanation of your neck pain, or else 98% of people would have neck pain”!

Interpreting diagnostic imaging findings can be confusing, misunderstood and misinterpreted. This can lead to unnecessary anxiety and inappropriate treatment planning.  Occasionally a patient will have a finding of a myelopathy, advanced disc prolapse or extrusion (a burst spinal disc), or a fracture. These are indeed serious findings that should be dealt with appropriately.  When it comes to non-traumatic musculoskeletal injuries or conditions, these findings are rare.  The take home message is that the majority of diagnostic findings are likely not “abnormal” and are only a piece of the puzzle. Other factors such as nerves, shortened muscles, repetitive postures, and muscle imbalances are more likely the cause of pain.  Often muscle imbalances and shortened muscles can put pressure on a joint, exacerbating an underlying degenerative process. Once the muscle balance, strength and proper posture can be restored, the pain will subside. The degenerative process is still there, therefore was likely not the CAUSE of the problem.

Having an injury and suffering with pain is no light matter. That in itself can be stressful and confusing.  Do you NEED an Xray or MRI? In most cases, the information gathered with those tests will not change the course of treatment. With this in mind, understanding the results and discussing them with your physiotherapist can help to alleviate feelings of helplessness and anxiety.  We will thoroughly assess your body to identify underlying processes that may lead to further joint compression, mal-alignments and muscle imbalances.  We have the knowledge to identify risk factors for more serious conditions that may need further diagnostic testing and will refer you on as appropriate.

If you have diagnostic reports that have left you feeling helpless and ‘left out to pasture’, we would love to discuss them with you, assess, treat and educate you on how to manage your pain most effectively.

Jennifer Gordon (BSc.PT, BA Kin, AFCI)