Back pain can be severe and debilitating. Thankfully we have cutting edge technology such as MRI scanning machines that can see right into the body and tell us exactly what and where the problem is so we can get better FAST right? WRONG.
The evidence suggests that having an MRI early in a workers back pain episode will hinder recovery – not help it.
So what’s the problem?
MRIs find stuff. Often lots of stuff. Disc bulges, degenerative changes and a whole lot of other nasty sounding stuff. NORMAL stuff. That’s right – NORMAL. Normal age related conditions such as disc bulging and herniation are present in high percentages of the pain free population.
For a worker with simple non-specific low back pain (that may even be severe and debilitating) to hear that their MRI report showed they have a disc bulge and degenerative changes can have damaging effects on their beliefs about their injury and delay recovery. All this when the MRI findings may not be associated with their actual symptoms. We call this stuff ‘incidental findings.’
“My back is stuffed”
I’ve lost count of how may times I have heard this. Once a worker is told they have degenerative changes in their back or a disc bulge it can be hard for them to let this go, and it unnecessarily begins to modulate their behaviour. Disc bulges, degenerative changes and all the other bad sounding 'stuff' often found on MRIs are present in most PAIN FREE adults and they are NOT predictive of future back pain.
So who should have an MRI?
MRIs are vital in the detection sinister pathologies such as cancer or infection. These ‘red flag’ conditions usually behave differently to normal back pain. GPs and physios screen all patients for these ‘red flags’ during the patient interview and refer patients for MRI as necessary. An MRI may also be warranted if the injury has occurred through severe trauma (e.g. fall from height).
MRIs may be considered for a type of back pain known as ‘radiculopathy’ (leg pain and progressive sensation loss, muscle weakness) and are used to confirm diagnoses, guide steroid injections or plan more invasive treatment. However, these are not the first line of treatment. They are usually only considered after a period of conservative care.
So what can you do?
If your company GP routinely sends workers with back pain for scans – get a new one.
Make sure have an experienced workplace physio on your team to provide the crucial early intervention for work related back injury. This early treatment usually involves giving the worker the crucial education they need to guide them on the path to recovery – not disability.
To learn how your business can reduce workplace back injury costs CLICK HERE.
