Do I need a scan before I see a Physio?
If you have developed pain or sustained an injury, you may assume that you need imaging before seeing a physiotherapist. For many common muscle, joint and tendon problems a scan is not required before physiotherapy can begin. A thorough discussion in combination with a detailed assessment is usually a sufficient starting point to determine an initial management plan.
What can a physio assess without a scan?
Prior to conducting a physical assessment, your physio will gather details around the nature of the injury. This includes:
- How and when the symptoms began
- Whether there was a particular mechanism that resulted in the injury
- What movements aggravate the pain
- How the symptoms behave throughout the day
- Your medical history and prior injuries
The physical assessment may include assessing range of motion, strength, balance and functional tasks. Specific clinical tests can also help determine which structures may be involved.
What are the different types of scans and when are they used?
- Xrays: commonly used to examine bone and joints. They may help identify fractures, dislocations and arthritic changes. They provide less information about muscles, tendons and ligaments.
- Ultrasound: can examine superficial soft tissues, including tendons, muscles and bursae
- MRI: provides detailed images of soft tissue, including muscles, tendons, ligaments, cartilage, discs and nerves.
- CT scan: uses multiple mages to provide greater detail about bones and complex injuries
Why isn’t a scan always necessary?
Scans show the physical structure of the body, but they do not always explain why someone is experiencing pain. Imaging can identify changes such as disc bulges, joint degeneration, muscular and tendon injuries as well as fractures. However, some of these findings are also present in people who have no pain at all. This means a scan must always be interpreted alongside clinical signs and symptoms.
Imaging is most helpful when it is likely to confirm or exclude a particular diagnosis, change the recommended treatment, guide a surgical decision or investigate symptoms that have persisted despite conservative management. If the result is unlikely to change what you do next, a scan may add unnecessary cost.
Research involving people without back pain found evidence of disc degeneration in approximately 37% of people in their twenties, increasing to 96% of people in their eighties. Similarly, MRI studies have identified meniscal tears, cartilage changes and tendon abnormalities in people with completely pain-free knees and shoulders. These findings are often similar to wrinkles or grey hairs; they may represent normal changes that occur over time.
Key takeaways
For most common muscle, joint and tendon problems you don’t need a scan before seeing a physio. A physio can assess your condition, begin appropriate management and determine whether imaging is likely to change your treatment. If pain or an injury is limiting your movement, work or exercise, you can book a physiotherapy assessment without waiting for a scan.
