To Scan or Not to Scan: Is it Always Medically Necessary?

July 20, 2017

 

What did we do before the MRI? Before the CT scan or X-ray?

 

 

The number one reason someone visits a Physiotherapist is to get relief from pain.

 

 

When a patient presents to us, our primary objective is to get a clear clinical picture. We take a detailed history and perform a thorough physical examination. This process gives us valuable information on a patients’ posture, biomechanics and function.

 

 

By putting it all together we form a hypothesis of what we think is contributing to their pain or injury.

 

 

Physiotherapist’s are experts in movement dysfunction and an integral part of that is aiding in the healing process of injuries. This includes injuries related to muscle, tendon, ligament, bone, disc and nerve.

 

 

Soft tissue injuries such as ligament sprains can take 2-3 months to heal.

 

 

Disc injuries in the lower back can easily settle within 4 to 6 weeks or less, but may take a couple more months of rehabilitation to strengthen the back and abdominals and condition for return to work and/or sport.

 

 

Every injury has its healing timelines.

 

 

Today, more and more people are getting scans that are unwarranted.

 

 

Having pain in your back or your knee is not reason enough to get an MRI.

 

 

I see numerous patients who have not even been referred for conservative management. When symptoms don’t improve with rest and medication, many doctors send them straight for a scan!

 

 

Important questions we need to consider:

  1. How old is the injury? Has it been a week or one year? Acute injuries require time to heal.

  2. Has there been any conservative management? This could include physiotherapy, exercise physiology, massage, etc.

  3. Is there a gross loss of power or change in sensation? Is it one extremity? Two or more? This may indicate serious nerve or disc injury and may require surgery!

  4. Is surgery being considered? All surgeons will want an MRI to assess the area being considered for surgery, whether it is for the spine or knee.

  5. Is a cortisone injection a treatment option? If so, a CT scan will be warranted to ensure the treatment is specific.

  6. Does the history indicate something more serious? Do we need to rule out cancer or serious infection?

 

 

So why is it that more and more people are having unnecessary scans?

 

 

Is it because the doctor is lazy?

 

 

Well, no.

 

 

But we live in a more litigious world so they often need to cover all their bases. This is can influenced by insurance companies and claims.

 

 

They may also just not know how valuable physiotherapy can be for pain management and injury rehabilitation.

 

 

Or maybe it’s because we are more impatient. 

 

 

We want to know what exactly is wrong and we want it fixed yesterday. And living in Australia where we have a mix of public and private healthcare, you can easily phone up and get an MRI the same day and pay out of your own pocket.

 

 

In countries like Canada, where healthcare is 100% public, you may have to wait 3 months to get a CT scan or MRI.

 

 

But here’s the thing.

 

 

Getting a scan often doesn’t change the management of your injury.

 

 

Not one bit.

 

 

For sure, there are many exceptions and cases where it is absolutely necessary to get a scan. But for the most part, you need to go see your Physiotherapist who can assess you, diagnose your problem and educate you on the healing timelines. What to do, what not to do, etc, and most importantly, get you moving!

 

 

 

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