Is that image necessary?
88% of Americans will experience low back pain that impairs function at some point in their life. Low back pain is the #1 cause of job related disability. Oftentimes, individuals seek out urgent care or primary care which then leads to imaging or prescriptions. 50 billion dollars is spent treating low back pain pharmaceutically and 50% of imaging has been found to be medically unnecessary for acute low back pain (Koch et al., 2018).
When spinal degeneration is found on imaging, spinal fusion surgery is often a recommendation to improve pain. The rate of elective spinal fusion surgery in the US increased by 62% from 2005-2014 with costs for the procedure exceeding 10 billion dollars, despite the fact there is NO strong evidence for surgery vs non-surgical care (Traeger et al., 2019).
Every clinical practice guideline, in 2018, recommended against imaging for non specific low back pain and recommended for exercise (Oliveria et al). So why are we spending so much money on unnecessary medical costs?
Equally important to the low back, is the unnecessary imaging for shoulder pain. According to Yamomato in 2011, more people with rotator cuff tears on imaging are asymptomatic than symptomatic. Barretto found that individuals with single sided shoulder pain receiving imaging of both shoulders had the SAME amount of abnormalities on both sides (2019). Barretto also found that imaging regularly detects abnormalities of the rotator cuff, bursa, acromion, biceps tendon and labrum in asymptomatic individuals.
So why do we care? Your image does not tell the whole story, and from the evidence above it clearly does not accurately represent your symptoms. In physical therapy, we want to listen to your story and figure out how to best help you. We want to help you with the functional component of life, like picking up your laundry basket from the ground without pain. Your image should not define you. We don’t want you to spend unnecessary health care dollars on imaging, surgery, or opioids that can have serious side effects if you don’t need to. Reach out if you have any questions about how physical therapy can be the first line of defense instead of the last!
Lexi Noel, DPT
Loon State Physical Therapy
