Physio for back pain? Do I need a scan?


How targeted physio for lower back pain can help reduce pain

Require physio for lower back pain? You’re not alone. Lower back pain is the most common presenting complaint in the clinic on a daily basis. It is estimated that 85% of the Australian population suffer from lower back pain at some stage during their lives. 70-80% of sufferers will recover from an acute episode of lower back pain within a 3 month period. However, 20-30% of sufferers will suffer from persisting pain and loss of function. In fact, reoccurrence rates are as high as 80%.

So what kinds of back pain are there? Lower back pain can be categorised under these three broad headings; specific pathoanatomical lower back pain, serious pathological lower back pain and non specific lower back pain.

Pathoanatomical Pathology

5-10% of lower back pain can be diagnosed, with pain originating from structural pathology affecting things like the vertebrae, discs, ligaments, nerves and other tissues. 

Serious Pathology

1-2% of lower back pain is caused by serious pathology, such as infectious and inflammatory disorders, or even malignancies. Diagnosis is important and special attention to be paid to the nature of the pain, and the nature of it’s onset.

Non Specific Lower Back Pain

90% of lower back pain sufferers have no specific structural diagnosis as a cause for their pain. Contemporary evidence supports the notion that lower back pain is not just structural. It’s associated with a combination of factors, including pathoanatomical, physical, psychological, social and behavioural.


So does my back pain mean I should get a scan? 

In most cases evidence demonstrates that undergoing an early and unnecessary MRI, results in a poorer prognosis. It also indicated an increased likelihood of time off work, and increased the possibility of surgery.  Fear and pain beliefs have been shown to have a very powerful effect on the outcome of someone with lower back pain. Therefore choosing when it’s appropriate to scan, is very important. Likewise, interpreting scan findings is also crucial.

Scans can be misleading. This is due to evidence showing a poor correlation between structural findings, with levels of pain and disability.  Studies conducted on people without lower back pain have shown a high prevalence of abnormal findings on MRI scans (see table below). As demonstrated in the table, by 40 years of age, 50% of people without lower back pain have a disc bulge. Similarly, by 50 years of age 80% of people have disc degenerative changes. Now remember this table includes people without pain. Imagine only scan results were used to diagnose the causes of back pain!


So what do I do?  

It’s essential a qualified health professional properly assesses the cause of lower back pain.  A good assessment will involve a thorough history and a physical examination. If there are neurological symptoms, or suspicion of a serious pathology, a scan may also be required. Likewise a scan may be recommended if clinically relevant. Otherwise don’t rush for a scan as it may not help your cause.

Contact our Sandringham Physiotherapy practice on 03 9521 6633 or book your appointment online.


O’Sullivan P. It’s time for change with the management of non-specific chronic low back pain. Br J Sports Med 2012;46:224–7.

Brinjikji W, Luetmer P, Comstock B et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol 2015;36(4):811–6.

Jarvik JG, Hollingworth W, Heagerty PJ et al. Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine 2005;30:1541–8. 7. Webster BS,

Cifuentes M. Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes. J Occ Environ Med 2010;52:900–7.

Brukner & Khan’s Clinical Sports Medicine,  5th ed. Peter Brukner, Karim Khan Sydney: McGraw-Hill Australia;  2017




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