Do I Really Need a Scan?
We often get ask whether a scan is necessary. The short answer in most cases, no.
Scans, such as X-rays, MRIs, or CT scans, are typically recommended only in specific situations, such as when a serious condition is suspected, symptoms are worsening, or when conservative treatment has not been effective. It’s also important to note that scans can sometimes be misleading. They may show age-related or normal changes in your spine, joints, or soft tissues that are not actually the cause of your pain. This can lead to unnecessary worry, anxiety, or even fear of movement (known as fear avoidance). For the majority of musculoskeletal conditions—including common issues like back pain, neck pain, and shoulder pain—a scan is not required. Instead, a thorough physical assessment and evidence-based treatment plan are usually the most effective approach.
When Scans Are Useful:
Suspected serious condition. If a serious underlying issue is noted, often called "red flags," a scan may be used to confirm or rule out the condition.
Red flag symptoms (severe unexplained pain, night sweats, history of cancer, unexplained weight gain or loss).
After trauma (suspected fracture, ligament, tendon tear, dislocation).
Significant Neurological symptoms (numbness, tingling, weakness, loss of bladder/bowel control).
Persistent or worsening symptoms. A scan may be considered if pain is not improving despite following physiotherapy.
Assessing specific injuries. For certain injuries like significant ligament or tendon tears (ACL tear), a scan can help assess the severity of the damage.
When conservative care has not helped and surgery is being considered.
Why Scans Aren’t Always Necessary:
Most back and neck pain improve with movement, strengthening, and time.
Mild sprains and strains are best treated with physiotherapy.
“Wear and tear” findings (like disc bulges, herniations or arthritis) are common even in people without pain or symptoms.
Scans can be misleading. It is very common for scans to show "abnormalities" like disc degeneration or arthritis in people who have no pain at all. Focusing on these findings can increase fear and anxiety, potentially slowing recovery increasing fear avoidance.
The treatment plan might not change much. In most cases, a scan won't alter the recommended physiotherapy treatment plan, which is usually a combination of exercise, activity modification, and manual and soft tissue therapy.
“Labelling” an issue: Obtaining a diagnosis based on an incidental finding can make you feel more fragile or unwell than you actually are. This can lead to a state of heightened anxiety, sometimes referred to as "scanxiety".
Common Myths About Scans
“If I get an MRI or X-Ray, it will show exactly what’s wrong.”
→ Not always true. Many “abnormal” findings are normal age-related changes.“If my scan looks bad, my pain or symptoms must be bad.”
→ Pain doesn’t always match scan results. Some people have severe changes (on scans) with no or minimal pain/symptoms, and others have pain with a “normal” scan.“I need a scan before physio can help.”
→ In most cases, physio assessment and treatment can start right away not delaying your treatment and recovery.
Why Start with Physiotherapy?
In many cases, a clinical diagnosis is all you need—helping you avoid unnecessary scans and delays in starting treatment.
A Physiotherapist is trained to:
Take a detailed medical history
Perform a comprehensive physical examination
Accurately identify the source of your pain
This thorough assessment often provides all the information required, especially for common musculoskeletal problems such as muscle strains, sprains, back pain, neck pain, and joint injuries.
Early movement and gentle strengthening can help recovery more than waiting weeks for a scan.
If we note “Red Flags”, clients will be referred to look into the issues further (consultant, GP, Scans).
