April 12, 2023
Low back pain is jarringly common. About one–half of all working Americans experience symptoms at least once every year, and roughly 31 million are affected by it at any given point in time. So if you happen to place yourself in this category, you’ll have an abundance of company.
Dealing with low back pain can be troublesome and place a strain on everyday life. Typical movements like bending over to pick something off the ground or twisting your torso when looking to the side might suddenly make you pause and cause you to be less mobile as a result. This naturally leads to frustration and can often shift to a focus on one main question: “what’s causing my pain?”
Many patients with low back pain therefore begin to place a strong emphasis on obtaining a diagnosis. Patients who do this usually believe that obtaining a diagnosis will clearly explain what’s causing their pain and will make it easier for them to receive appropriate treatments. But sadly, searching for a low back pain diagnosis is complicated and often does not lead to the outcomes that most patients hope for. And in many cases, it can do more harm than good.
When seeking a diagnosis, many patients will have an imaging test (X–ray, MRI, or CT scan) performed, either by the doctor’s order or their request. These types of tests are essential for diagnosing numerous conditions throughout the body, but when it comes to low back pain, their usefulness is limited. The primary issue is that imaging tests are only one component of a diagnosis, in addition to a detailed patient interview and thorough physical examination. Plus, many “abnormal” results from imaging tests could be simple age–related changes that are not contributing to a patient’s pain, but this won’t stop certain practitioners from treating the “problem” nonetheless.
Clinical guidelines and experts have long recommend that imaging tests for low back pain should only be performed if one or more “red flags” is identified during an examination. Red flags for low back pain include the following:
- Loss of bladder or bowel control
- Signs of severe or worsening nerve damage
- Serious underlying problems like cancer or spinal infections
- Unexplained weight loss
- Abnormal reflexes
- Recent serious fall or injury
- Worsening numbness or weakness in one leg
If none of these red flags are present, having an imaging test is not recommended because it’s not likely to provide any valuable information or lead to better outcomes. Yet many patients with low back pain and no red flags still undergo MRIs of their spine.
Greater use of healthcare services leads to higher costs for patients undergoing MRIs
A 2015 study illustrates the implications of unnecessarily having an MRI for low back pain instead of seeing a physical therapist. For the study, researchers analyzed data from the medical records of 2,893 patients with low back pain that were identified through a comprehensive search. Of these patients, 841 received treatment outside of primary care within the first six weeks of their diagnosis, with 46% receiving a diagnostic test—usually an MRI—and 45% receiving physical therapy.
A comparison of these two groups showed that those who received a diagnostic test first utilized significantly more healthcare services than those who underwent physical therapy first. For example, patients who first received a diagnostic test were more than 3 times more likely to undergo surgery, almost 4 times more likely to have injections, and about 7 times more likely to see a spine surgeon compared to those who saw a physical therapist first. As a result, healthcare costs for low back pain over one year were about $4,700 higher when imaging was performed first due to the increased use of these healthcare services.
This study clearly shows why it’s usually best for patients with low back to visit a physical therapist early after noticing pain rather than going to a primary care physician or specialist, who may be more likely to order a diagnostic test. With this in mind, we strongly recommend that you consider seeing a physical therapist if low back pain is bothering you and to avoid the temptation of relying too heavily on a diagnosis for the reasons we’ve described here.