IN MY DAY job, I see the impact of back pain on patients every day. I work as a Clinical Specialist Physiotherapist at the Mater Hospital as part of a novel integrated care pathway for managing low back pain across the hospital and its community partners in Dublin city.

Many of the patients I meet have already had an MRI scan or some other form of imaging done. They often arrive with the results of their scan, expecting that it reveals the cause of their pain. The expectation that if my back hurts, there must be something structurally wrong that can be seen on a scan has become commonplace.

We live in a fast-paced, instant-gratification culture, and when pain or injury finds its way into our lives, having a scan can seem like the most reliable and necessary way to establish a diagnosis and get the symptoms “fixed”.

Yet when I assess these people clinically, the picture is often much more complicated and nuanced. Most people with back pain do not have a single structural abnormality that neatly explains their symptoms, and many of the changes seen on spinal MRI scans are also common findings in people who have no pain and can be linked to the ageing process.

MRI isn’t the catch-all

This raises an important question about the culture of imaging in healthcare today: have we become too focused on finding something on a scan, rather than listening and understanding the person sitting in front of us and the importance of a comprehensive clinical physical examination?

If you develop low back pain, one of the first things you may think is I will go to my GP because ‘I need an MRI’. It is an understandable reaction. Back pain can be worrying and when severe, very debilitating. It can stop you doing the things you normally do and make daily activities such as sitting, driving, putting your shoes and socks on difficult.

However, bouts of back pain are perfectly normal. Most episodes of lower back pain are not caused by a serious underlying condition but occur as a result of a particular activity or repeated movement and will improve with time.

Yet, for some reason, people seem to interpret low back pain very differently from pain elsewhere in the body. Often people with knee pain may hobble around and think, ‘I’ve probably done something to it. It will settle.’ But when people develop back pain there can be an immediate sense that something much more serious is going on.

Alamy Stock Photo Alamy Stock Photo

Perhaps back pain is associated with the spine column and spinal cord, and there is a perception that this is more serious than pain elsewhere in the body. Back pain, like any other musculoskeletal pain, is a normal part of life. It can flare up, it can be painful and limiting, and then it can settle. Evidence shows that most people with low back pain experience substantial improvement within the first six weeks, with the greatest improvements occurring early........

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