Current Clinical Practice Guidelines (CPGs) for acute back pain is for conservative care (we will explain that in a minute). Only certain patients require X-rays (or other imaging studies) in the first six weeks following the injury. Even so, research does show a high rate of early MRI among Workers’ Compensation patients.
A recent study looking at the use (and possible over use) of MRIs in Workers’ Compensation found that the folks most likely to have early MRIs include: men, workers with high levels of fear of reinjury, and greater injury severity and disability. Workers who had the lowest rate of early MRIs were first seen for their low back pain by a chiropractor. In contrast, workers who went to a medical doctor (general practitioner, neurologist, or orthopedic surgeon) were the most likely to receive an early MRI.
Okay, so who does need early imaging? Anyone with signs and/or symptoms that suggest a bone fracture, infection, or tumors. Anyone with suspicious neurologic symptoms. And young patients (under 20 years old) or older adults (over 50 years old) require special consideration for advanced imaging.
Some medical doctors routinely order MRIs right away — even though current evidence doesn’t support this practice. Chiropractors rely on X-rays taken in their offices rather than on MRIs provided somewhere else. So if you see a chiropractor, you may automatically have X-rays taken. Workers who are afraid to go back to work for fear of reinjury make up a large percentage of patients who have an MRI for an acute episode of injury-related back pain.
If you do not have any of the red flags mentioned and don’t fall into the two age categories in question, then you may be a good candidate for the conservative care we mentioned earlier. This can include a short period of rest (one or two days) but usually the emphasis is on staying active. Activities can be modified to help you maintain good posture and alignment and avoid painful symptoms. Mild pain relievers such as Tylenol or ibuprofen (ibuprofen is also an antiinflammatory) may be prescribed.
If you do not experience improvement in your symptoms in the first two weeks after the initial episode, then a few visits with a physical therapist may be a good idea. Additional imaging studies with X-rays or MRIs are not advised unless conservative care has failed to provide relief from painful symptoms or you develop any of the red flags mentioned.