Osteopaths, like doctors, sometimes need more information than clinical examination alone can give. A patient might present with low back pain that doesn't follow the usual patterns:
- Pain on flexion (bending forward) usually indicates a problem with the disc, including a possible disc bulge
- Pain on extension (bending backward) usually indicates a problem with the vertebrae, including possible spondylolisthesis (forward slippage of one vertebra over another)
When the clinical picture doesn't fit, medical imaging is sometimes needed. It isn't always the first port of call though. Most osteopaths give around 6 weeks from the initial presentation before requesting imaging, if there has been no improvement. If treatment isn't moving the needle, the diagnosis may not be quite right.
Which scan, when, and what it shows
- X-ray is useful for bone structure and suspected fractures.
- MRI is detailed soft-tissue imaging. An MRI of the spine is requested instead of an x-ray if, for example, a disc bulge is suspected.
- Ultrasound is high-resolution, dynamic assessment of soft tissues. It can also be used to guide interventions such as injections, and gives more detail of local anatomy than an MRI does.
- CT gives enhanced detail of bone pathology and is useful for guiding interventions such as injections.
Images are reported by specialist radiologists. Their report details what was found and possible reasons, which gives the osteopath a much clearer picture for continuing treatment. We can talk you through the images and the report in detail if you bring them in.