Why we usually don’t scan your back
“My back hurts, I should get it scanned.”
It is the most natural thought in the world. Something is wrong, so let’s look at it. The same way you would for a car or appliance that stopped working.
Unfortunately, for most back and neck pain, the scan won’t tell us much. It rarely changes what we do.
And a fair amount of the time it makes things worse rather than better.
I know that’s counterintuitive, so let me explain what I mean.
What a scan is good at
Think about your computer packing up. Your first move isn’t to unscrew the case and stare at the motherboard. Almost always the fault is in the software, not the physical hardware you can see.
A scan of your spine is a photograph of the hardware. Bones, discs, joints, the shape of things.
What it can’t show is a nerve that has become irritable and inflamed.
It can’t show a nerve pathway in the spine that is upregulated and firing more than it should.
It can’t show how your tissues are behaving under load, or how your system is regulating pain today versus last Tuesday.
Those things are real, they are physical, they happen in your body and not in your head, and they are the ones that usually drive persistent back pain.
We just don’t have a camera that photographs them yet.
What you might not expect
Here is what a scan does show. This is from a review of 3,110 people who had scans and had no back pain at all.
| On a scan of a pain-free person | Age 30 | Age 50 | Age 70 |
|---|---|---|---|
| Disc degeneration | 52% | 80% | 93% |
| Disc bulge | 40% | 60% | 77% |
| Worn facet joints | 9% | 32% | 69% |
So if you are 50, there is a decent chance you have a bulging disc right now. A slipped disc, in the old language. Sitting there, doing nothing, causing you no bother whatsoever.
Scan a hundred pain-free fifty-year-olds and you will find eighty spines with “degeneration” on the report. It is closer to grey hair or wrinkles than to damage.
Which is why finding one of these things on your scan tells us so little. It doesn’t mean it isn’t there. It means it was probably there before your back started hurting, and it will still be there long after your back has settled down.
Why this can actually cause harm
Once you have seen a word like degeneration on a piece of paper with your name on it, it is very hard to unsee.
A survey across five countries found that most people reading these ordinary, unremarkable terms took them to mean something serious was wrong with their back. Around half said the words would make them frightened of moving.
I understand that completely. The scan feels concrete. It feels like an answer. Compared to me saying “let’s load your back and see how it goes over six weeks”, a photograph with a finding on it feels far more solid.
But we have decent research showing that people who get scanned early for ordinary back pain tend to do slightly worse, not better. Not because the scan hurt them. Because of what happens next: the fixation, the fear of movement, the sense of a broken part that needs fixing.
When we do scan
This is not a policy of never. There are situations where we will refer on.
- Nerve symptoms that are getting worse. Weakness that is progressing, numbness spreading, changes in bladder or bowel function. This is the one to act on quickly, not wait on.
- Pain that hasn’t shifted despite doing the right things. If we are six to twelve weeks in, you have been consistent, and nothing is moving, then a scan becomes genuinely useful. It may well change what we do next.
- A history that raises a different question. Certain patterns, certain medical histories. You would know, because I would tell you.
So when I say we don’t recommend scans often, it doesn’t mean we never do.
One from the clinic
I saw a guy recently who came in with a scan already done, showing one vertebra sitting slightly forward of the one below it. Understandably, he arrived certain this was the cause. It has a name, it is visible, and it does look quite concerning.
Except his pain was in a slightly different place to where that would put it, and it behaved in a way that didn’t fit. So we largely set it aside and treated what was actually in front of us, which was a back that had become intolerant of bending and needed loading properly.
He got better. The vertebra is still exactly where it was.
This will change
I want to be straight about this. Imaging is improving. There is research now looking at inflammation in nerves, at how pain signals are being processed, at things conventional scans were never designed to pick up. Some of it looks promising. If those tools mature into something that changes how we treat you, we will use them.
But that is the future, and this is now. Right now, a scan of the hardware is a blunt instrument for a software problem.
The thing I most want you to take away
A normal scan does not mean nothing is wrong with you.
If you have been told your scan is clear and walked away feeling dismissed, or quietly wondering whether people think you are making it up: your pain is real, and it has a real biological cause. The camera was just pointed at the wrong thing.
That is a very different conversation to “there’s nothing there”.
If you’re worried about your back and wondering whether you should get it scanned, get in touch and we can talk it through properly. Happy to look at your particular situation rather than the general case.
Ian
General guidance, not a diagnosis. If you have progressive weakness, numbness in the saddle area, or any change in bladder or bowel control, don’t wait for an appointment with us. Contact your GP urgently or go to A&E.