Should I get Imaging?Nov 08, 2022
Imaging (x-rays, MRIs, CT scans, etc.) is common in the medical profession and we often have patients choose to bring in their imaging to their first appointment. Imaging can be helpful to rule out certain pathologies, but it also is only one piece of the puzzle. In fact, we actually don’t need your imaging to get started.
As physical therapists, we rely more on our physical assessment and the information provided by the patient to determine a diagnosis and plan of care. For example, if the patient’s pain gets better with one movement and worse with another, we are able to collect this information as data points and incorporate it into the larger picture of what is going on with the patient. Imaging provides data points as well. The data points of imaging can sometimes be misleading depending on how they are interpreted and how much weight is given to what is observed. For instance, you can see evidence of arthritis on an x-ray, but that x-ray also doesn’t provide a timestamp of when symptoms first occurred. On the other hand, vertebral disc bulges have been observed on MRIs of completely healthy patients without any mention of symptoms.
False positives or “incidental findings” are sometimes identified with imaging. These are other findings unrelated to the issue the patient is experiencing. This can include findings of arthritis, disc bulges, or entrapped nerves to name a few. The person has no idea these factors are present because they are not experiencing any symptoms related to the structures examined on the imagining. This can lead the patient to unnecessary concern or stress despite having no symptoms. These incidental findings can also sometimes lead to an incorrect diagnosis.
Let me tell you about one of our patients, Jon. Jon had experienced pain down his right leg, and saw his physician. He had some imaging done and the physician shared his interpretation of them with Jon. The physician told Jon that his symptoms were incorrect because the imaging showed the pain should be down the opposite leg– his left leg. Can you imagine how Jon felt with this? He started his visit with a medical practitioner invalidating his pain and telling him his pain didn’t make sense, all based on the imaging.
We’re all unique. Different issues may present differently with each person due to hydration level, previous activity level, or the individual’s personal feeling of their pain interpretation. We understand that and that’s why we create a “problem list” during the initial evaluation. This list consists of unique issues that need to be corrected specifically for each individual. We then create a plan to solve the “problem list” and guide each patient through their unique journey, correcting issues along the way.
So, when is imaging appropriate? We normally will ask a patient to get imaging when their symptoms don’t follow a normal clinical pattern, if they are not making progress after a few visits despite keeping up with their program, or when they show signs of red flags that need to be ruled out. So imaging is a piece of the puzzle, but definitely not the whole picture.
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