One of the most common questions we get is:
“Should I get a scan?”
Whether it’s an MRI, X-ray, or ultrasound, many people assume imaging is the next step when pain doesn’t settle quickly.
But here’s the reality:
• Most musculoskeletal injuries do NOT need imaging early on
• In some cases, scans can actually make things more confusing
When Imaging Is Actually Needed
Imaging is important in specific situations, particularly when we need to rule out serious pathology.
Clinical guidelines recommend imaging when there are “red flags”, such as:
• Significant trauma
• Suspected fracture
• Neurological deficits (e.g. progressive weakness)
• Signs of infection or malignancy
According to the American College of Physicians, routine imaging for low back pain without red flags is not recommended (Qaseem et al., 2017).
Why Scans Often Don’t Change Your Management
A key point most people don’t realise:
Your treatment plan often doesn’t change based on imaging.
For example:
• Muscle strains → rehab
• Tendinopathies → progressive loading
• Many disc issues → conservative management
High-level evidence shows that early imaging does not improve outcomes for most musculoskeletal conditions (Chou et al., 2009).
The Problem With Incidental Findings
Scans frequently show abnormalities, even in people with no pain at all.
• Disc bulges are common in people without back pain
• Rotator cuff tears increase with age
• Degenerative changes are often part of normal ageing
A landmark review found that imaging findings increase with age regardless of symptoms (Brinjikji et al., 2015).
Just because it shows up on a scan doesn’t mean it’s the cause of your pain.
When Imaging Can Be Helpful
There are situations where imaging is valuable:
• Symptoms not improving despite appropriate rehab
• Suspected structural injury requiring surgical opinion
• Pre-operative planning
• Significant instability or locking symptoms
Examples include true mechanical locking in the knee or suspected high-grade ligament injuries.
The Risk of Over-Reliance on Imaging
Overuse of imaging can lead to:
• Increased anxiety
• Fear of movement
• Unnecessary procedures
There is strong evidence that beliefs about structural damage can negatively impact recovery (O’Sullivan et al., 2016).
What Matters More Than a Scan
The best outcomes come from:
• A thorough clinical assessment
• Understanding your symptoms and goals
• A structured rehab plan
• Gradual return to activity
Clinical reasoning and active rehabilitation consistently outperform imaging-led management for most musculoskeletal conditions (Maher et al., 2017).
Our Approach at Trilogy Physiotherapy
At Trilogy Physiotherapy in Sinnamon Park, we don’t jump straight to scans.
• We assess how you move
• Identify the true drivers of your pain
• Decide if imaging is actually needed
• Build a structured rehab plan
If a scan is required, we guide you through the process and interpret results in context.
Final Thoughts
Scans can be helpful, but they are not always necessary.
In many cases, you don’t need a scan to get better.
What you need is the right diagnosis and a structured plan.
Need Help With Your Injury?
If you’re unsure whether you need imaging, we can help.
📍 Trilogy Physiotherapy – Sinnamon Park
🌐 trilogyphysiotherapy.com.au
📞 (07) 3148 8785
Appointments can be made online.
References
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816.
Chou, R., Fu, R., Carrino, J. A., & Deyo, R. A. (2009). Imaging strategies for low-back pain: Systematic review and meta-analysis. The Lancet, 373(9662), 463–472.
Maher, C. G., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736–747.
O’Sullivan, P., Caneiro, J. P., O’Keeffe, M., Smith, A., Dankaerts, W., Fersum, K., & O’Sullivan, K. (2016). Managing low back pain through behaviour change. British Journal of Sports Medicine, 50(21), 1282–1284.
Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline. Annals of Internal Medicine, 166(7), 514–530.
FAQS
Do I need an MRI for back pain?
Most people with back pain do not need an MRI unless there are red flags such as trauma, neurological changes, or suspected serious conditions (Qaseem et al., 2017).
Why do scans show problems even when I feel fine?
Imaging often shows normal age-related changes like disc bulges or tendon wear that are not always the cause of pain (Brinjikji et al., 2015).
When should I get imaging?
If symptoms are not improving, or there is suspected structural damage, imaging may be helpful.
Can scans make my injury seem worse?
Yes. Findings can increase anxiety if misinterpreted, even when they are not clinically relevant (O’Sullivan et al., 2016).
What matters more than a scan?
A proper assessment, tailored rehab, and gradual return to activity are far more important for recovery (Maher et al., 2017).
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