Health & Fitness

Need an MRI for that Aching Back?

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You wrench your back swinging a golf club or lifting a heavy box out of your car’s trunk. Do you need an MRI or CT scan to assess the damage?

“If you have had low back pain for less than six weeks, usually pain medication and possibly physical therapy are the best ways of managing the problem,” says Glen Stream, M.D., board chair of the American Academy of Family Physicians (AAFP) and a family physician in Spokane, Washington. “Imaging tests don’t speed recovery or affect treatment and CT scans and x-rays can cause unnecessary radiation exposure.”

The AAFP is one of 26 medical organizations that have provided lists of overused, often unnecessary medical tests to Choosing Wisely, a national campaign aimed at helping doctors and patients discuss what tests or treatments are truly necessary and won’t cause undue harm. “The list is based purely on what’s best for patients and not what is cost-effective,” says Dr. Stream.

When might you need an imaging test for your back pain? If the cause of the pain is unclear, if it resulted from a bad fall or accident, if your nerve function is affected (causing symptoms such as weakness in one or both legs, if you have diminished bowel or bladder function) or if you have signs of infection (fever, chills) in addition to back pain.

Tests

Here, is information from the National Institutes of Health on tests that can get to the bottom of your back pain:

X-rays:

These are painless procedures but they do expose you to some radiation.

Best for: identifying broken, fractured, or misaligned bones.

Discography and myelography

Procedures can enhance x-ray images through the injection of a special contrast dye into a spinal disc or the spinal canal. Best for identifying herniated discs, nerve compression, and some fractures not visible on x-rays alone.

Computerized tomography (CT)

X-rays are passed through the body at multiple angles to produce two-dimensional computer images of the internal structures of the back.

Best for identifying ruptured discs, damaged vertebrae, and spinal stenosis (narrowing of the space around the spinal cord, which causes pressure on nerves, producing pain and possibly numbness and tingling down into the buttocks and legs).

Magnetic resonance imaging (MRI)

Scanning equipment creates a magnetic field around your body that ultimately leads to two- and three-dimensional images of the body generated by a computer.

Best for identifying bone degeneration, or injury, or disease in tissues and nerves, muscles, ligaments, and blood vessels.

Thermography

There are other diagnostic scans available. Thermography, for example, uses infrared sensing devices to detect the presence or absence of nerve compression, and ultrasound imaging (sonography) uses high-frequency sound waves to obtain images inside the body. It can detect tears in soft tissue such as ligaments, muscles, and tendons.

Read more: Exercises that strengthen your back.

But simple back pain that lasts less than six weeks doesn’t require any scans at all, according to Choosing Wisely. To feel better:

  • Limit bed rest. After one or two days at most, it actually makes back pain worse.
  • Take anti-inflammatory medications to reduce pain and swelling. If over-the-counter painkillers aren’t working well, talk to your doctor about a prescription.
  • Use a cold pack or compress (such as a bag of ice or frozen vegetables) as soon as you injure your back, several times a day, for up to 20 minutes at a time.
  • After two or three days of cold, use heating pads or warm baths to relax muscles and increase blood flow.
  • Exercise! Gentle exercise speeds recovery and strengthens back and stomach muscles. Even a moderately brisk walk can get your blood moving and strengthen your abs. Work with a physical therapist to find the right set of exercises for you. (If you feel pain after 15 minutes or more of exercise, stop, and see your doctor.)

For more stubborn back pain, other therapies, including surgery, may be recommended. Talk to your doctor about what is best for you. To learn more, see the National Institutes of Health’s back pain fact sheet.

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