X-Rays, Ultrasounds and MRI's.. What's the point?

Physiotherapists are delicately poised as frontline health professionals and as part of our responsibilities, we are required to provide advice to you, our clients, on appropriate medical imaging. The Physiotherapists at MTM Physiotherapy Warwick are well educated in appropriate medical imaging and we consistently stay up to date with the most recent evidence-based literature.

We are commonly asked “Do I need a scan?”. However, our clients often come in with anywhere between 1 and 10 scans and quite commonly on the same body part! The aim of this article is to provide you with some understanding on what scans show us, why we might refer for you for a scan and how the results will influence (or not influence) our management plan for you.

X-Rays

An X-ray machine omits X-ray wavelengths to create a digital, two dimensional picture of internal body structures. X-rays are used to understand the bony makeup and is helpful in diagnosis of fractures. X-rays expose patients to radiation in small amounts. Therefore, it is safe, however, excessive radiation exposure is not recommended.

Ultrasounds

An Ultrasound machine consists of applying gel to the area of concern and use of a small probe, which emits high frequency sound waves. The sound waves are directed at the tissue in question and the reflected sounds/echoes then forms the image. Ultrasounds are commonly used to assess muscle and tendon make up and are useful in diagnosing the presence and location of tears.

MRI

Magnetic Resonance Imaging (MRI) scans uses magnetic and radio waves to create multiple images from different angles. It is especially useful at detecting things that will not show up in other medical imaging modalities.

When do we refer for MRI scans?

The Australian Physiotherapy Association makes the following recommendations regarding testing and imaging.

• Don’t request imaging for patients with non-specific low back pain and no indicators of serious pathology causing back pain.

MRIs are only recommended for patients that may have a serious disease like a cancer or infection. However, patients presenting with back pain are highly unlikely to be diagnosed with a serious disease or infection. Patients with a likelihood of serious disease can be identified with subjective and objective assessments that indicate red flags. MRI is also advised when there is worsening severe back pain amongst the presence of neurological symptoms.

• Don’t request imaging of the cervical spine in trauma patients, unless indicated by a validated decision rule.

Cervical spine imaging may be a very costly experience,as very few trauma patients have a spinal column injury. Your Physiotherapist will determine your need for imaging based on the Canadian C Spine rules.

• Don’t request imaging for acute ankle trauma unless indicated by the Ottawa Ankle Rules.

The Ottawa ankle rules are useful in determining clients that have sustained a clinically important fracture, dislocation or an osteochondral injury. Acute ligament injuries can be diagnosed clinically and treated symptomatically. When there are persistent symptoms that may indicate instability or internal derangement, MRI can be used.

How does Imaging influence our management?

Our Physiotherapistshave up to date knowledge of the current evidence-based literature about pain science and we believe in treating your presentation not your scan. If you take people who do not have back pain and put them through an MRI scan you will get some surprising results. So the moral of the story is to not be afraid of your scan results, it is all a part of the aging process!

Words like ‘degeneration’and ‘bulging disc’ are fear provoking andoften do not have a favourable outcome on patient prognosis. Therefore, as the evidence demonstrates that degeneration is common amongst a large percentage of spines, there is no need to image the spine for lower back pain presentations that are not indicative of serious pathology.

If an X-ray shows a fracture, depending on the type of fracture you will likely be referred on to one of our Orthopaedic Specialists who we work alongside. Furthermore, if there is a tear inside a muscle or joint surface, we will direct you to the appropriate specialist to speed up your recovery.

In summary, there are different types of medical imaging that target different types of tissues and these are chosen based on your Physiotherapist’sdiagnosis. Our Physiotherapists keep up to date with the latest evidence on guidance for Medical Imaging and are well trained in how your scans can facilitate management and rehabilitation.Written by Matt Beavis