Lower back pain myth No.4: I  need a scan

In fact, with the majority of lower back pain, imaging shows no specific identifiable cause. A lot of back pain may be caused by muscular spasm, muscle strains, and mild sprains to ligaments, which won't show up on imaging.

However, it is generally not necessary to definitively identify a specific tissue or structure. What's more important is to establish the bigger picture. This includes considering you as an individual and how the pain is affecting you, looking at your lifestyle and occupation and addressing factors that may predispose you to back pain, or may be helping to maintain it. Factors such as stress, tiredness, inactivity or unaccustomed activity may make your back sensitive to movement and loading.

The other side of the picture when it comes to imaging is that we now know (through doing a lot of imaging) that people with no back pain often will have specific findings like disc bulges. This tells us that disc bulges and other changes to the spine don't always cause back pain, and are a normal finding from our 30s onward. However, imaging reports that mention what are actually normal findings can often be a source of anxiety that may in fact worsen your experience of back pain.

If it's not likely to change the treatment or management of your back pain, there's little reason to do imaging, and it may have a negative effect. Imaging is only really indicated in the very small percentage of cases where other approaches, such as surgery, need to be considered.

A thorough case history and clinical examination, along with monitoring your response to treatment where appropriate, will ensure you get the right care for you.

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