Do I need to have imaging?
What is imaging?
Imaging is a tool that can be used to further investigate a patient’s presentation.
There are many different forms of imaging that can show us different tissues and structures.
The most common types of imaging referred by osteopaths are:
Magnetic resonance imaging (MRI)
Computed tomography (CT)
If your osteopath is considering imagining, they will have a conversation with you about which imaging modality would be most beneficial and why they believe you need it.
So, should I get imaging done?
As an osteopath, a frequent question we get asked is “should I get imaging done?”.
When answering this question, we use our history taking and osteopathic examination skills to decipher an answer:
Is this urgent or an emergency? Does this person present with ‘red flags’ that need to be referred to the General Practitioner (GP) or hospital?
YES – Refer to GP or call ambulance
NO – Continue osteopathic examination
Will the results from imaging change the way I treat or manage this patient?
YES – Refer for imagin
NO – Manage conservatively (through treatment and management) and refer at later date, if required.
When would my osteopath refer for imaging?
After a detailed case history, examination, and discussion with yourself, your osteopath may refer you to get imaging to further investigate your presenting complaint.
Depending on the type of imaging, any financial considerations and time sensitivities, we may refer you to the GP (who may then refer you to a specialist), which would allow you to access different Medicare rebates, for certain imaging techniques, which are no currently available for Osteopaths.
Typically, an osteopath will refer for imaging if they suspect any of the following:
Bone fracture or stress fracture
Worsening neurological symptoms e.g. loss in strength, loss of bladder control or bowel incontinence, saddle parasthesia
Underlying undiagnosed systemic condition e.g. gall stones, herniation, rheumatoid arthritis, bony spurs, tumours
If the presentation is not progressing with the natural healing time*
*At each consultation, your osteopath will re-assess your presentation and monitor for changes. In the case that your presentation is not healing within the typical timeframe expected for your presentation, or your presentation is getting worse, your osteopath then may refer you to get imaging to clarify or eliminate alternative diagnoses.
If I don’t get referred for imaging, then what?
This is great news, as we can get a jump-start on treatment and management! In the case that you are not referred for imaging, your osteopath will then have a discussion with you, regarding your diagnosis, the anticipated healing time frame, the strategies to help manage your presentation and a guide of when imaging may be reconsidered.
When imaging is not helpful
Let’s start with a word we often see on imaging reports, “degeneration”.
It sounds like a bad word, but it’s really not. I hope that after reading this section, you correlate the word ‘degeneration’ with ‘normal age-related changes’.
Although imaging shows a great deal of detail, receiving early imaging, when it is not indicated, can have a worse outcome than not receiving imaging at all.(1) This is because imaging can reveal abnormalities that are poorly correlated (aka not directly related) with your symptoms, and are actually just signs of natural aging.(1) Other negative implications from imaging can include increased medical costs, and an increased risk of unnecessary surgical intervention.(1)
Feel free to drop this fun fact at dinner tonight with your friends or family:
“People who are asymptomatic (have no pain), can also show disc degenerations, bulges and herniations on imaging”.
Well it’s true. As we age, it is completely normal for our spine to have degenerative (wear and tear) changes throughout, which can lead to disc herniations (bulges), without us even realising. A review found that greater than 50% of people aged 30-39 have asymptomatic (completely pain-free) disc degeneration, disc height loss, or a disc bulge present in their spine.(2) The study also shows that this increases as we age, as an estimated 70% of people younger than 50 years and an estimated 90% of people over 50 years also have disc degeneration in their spine while being completely pain-free.(2)
What that means to us as osteopaths is, that we don’t need to refer you for imaging straight away, as the results found on the report may not correlate with the pain you are experiencing and may actually show normal age-related changes which are present day to day, even when you are pain free.
In the case of acute low back pain (LBP)
Acute low back pain is a very common presentation we see as osteopaths.
For those who have experienced an episode of acute low back pain, it can be quite scary, as the pain can be debilitating.
It is normal to believe that you have seriously injured yourself, but don’t be alarmed, the current literature states that imaging should be delayed for 6 weeks in patients with LBP, without reasonable suspicion for serious disease.(3) This is because patients with lower back pain who have been managed well, should have substantial improvements in pain and function in the first 4 weeks, from their onset of pain.(3)
To further put your mind at ease, a study in Australia of 1172 people who presented with a new presentation of acute (<2 weeks) LBP, found a specific cause of back pain in 0.9% of participants, with fracture being the most common.(4)
It is also estimated that 70% of lower back pain is due to muscle strains or joint sprains, and only 4-10% are due to disc related pathology.(3)
At Retrain Health, our osteopaths, while definately not shy to refer for imaging when indicated, treat with the above stats in mind. After performing a thorough history taking and examination to eliminate any red flags, we work with our patients to decide on the best course of action for their individual presentation and needs.
What osteopaths can refer for and Medicare rebates:
Osteopaths are able to refer for imaging with a partial or full Medicare rebate, depending on the location we are wanting to view and the type of imaging we wish to use.
To make things easy for you, osteopaths can refer for imaging at the time of your appointment.
Generally, once you have a referral from your osteopath, you can book your imaging appointment at any radiology clinic in your area. Once the imaging has been performed, allow 2-3 days processing time before your osteopath has access to the imaging report.
For our lucky patients based in the Northern Rivers, we are able to electronically refer you to North Coast Radiology, who will then contact you to make your appointment at a time that best suits you.
In regard to Medicare rebates, click here to see a list of which x rays are eligible for a full or partial rebate when accessing with a referral from your Osteopath.
Medicare rebates (with osteopathic referral) for additional services such as US, MRI and CT vary between radiology clinics. As there are few factors to consider, in which your osteopath, GP and radiology clinic of choice, can help you navigate, determine eligibility and the best course of action for you.
Take home message:
Imaging is a useful tool that osteopaths may use when it is clinically indicated, but it is not always necessary. Your osteopath will always have a discussion with you regarding whether or not imaging is necessary.
Webster B, Bauer A, Choi Y, Cifuentes M, Pransky G. Iatrogenic Consequences of Early Magnetic Resonance Imaging in Acute, Work-Related, Disabling Low Back Pain. Spine. 2013;38(22):1939-1946.
Brinjikji W, Luetmer P, Comstock B, Bresnahan B, Chen L, Deyo R et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology. 2014;36(4):811-816.
Wáng Y, Wu A, Ruiz Santiago F, Nogueira-Barbosa M. Informed appropriate imaging for low back pain management: A narrative review. Journal of Orthopaedic Translation. 2018;15:21-34.
Henschke N, Maher C, Refshauge K, Herbert R, Cumming R, Bleasel J et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis & Rheumatism. 2009;60(10):3072-3080.
Retrain Health is based in the Northern Rivers, NSW. From our Byron Bay and Ballina clinics, our team provides a range of quality healthcare services and products.
Retrain Health offers osteopathy, remedial massage and strength and conditioning sessions, with qualified practitioners.
If you are interested in finding out more information or would like to book an appointment, please contact the clinic by phone (02) 6680 7447, send us an email or click here to book an appointment online.