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Sport Physiotherapy, Sports Medicine, Sports Therapy
A picture isn’t always worth a thousand words
January 26, 2018 | by Katie Wnuk

With increases in the sophistication of diagnostic imaging techniques (x-ray, CT, MRI, ultrasound, etc.) we are able to visualize internal structures better than we ever have before. However, just because we find something on imaging doesn’t mean that it is a problem or that it is generating pain.

In the past, it was thought that if a damaged structure or abnormal finding was determined on imaging, that structure was the cause of an individual’s pain. Yet, numerous studies have found that there may be a poor correlation between imaging and pain. This is especially important when a medical or surgical procedure may be considered to address the apparent problem, when that may not actually be the cause.

Here are two examples that remind us why diagnostic imaging should always be paired with a detailed assessment by the appropriate health care practitioner.

KNEE PAIN – MENISCUS

The menisci are two fibrocartilage discs that act to absorb compressive forces at the knee joint. Meniscal tears are a common injury, with arthroscopic surgery being the most frequent surgical procedure performed by orthopedic surgeons in the United States1.  Surgical intervention is associated with an increased risk of knee osteoarthritis2-4.

In a research study, a group of 991 healthy subjects, aged 50-70 years old, were randomly selected and underwent MRI imaging. The results showed meniscal damage as a common finding—with prevalence increasing with age5. Interestingly, they also found that more meniscal tears were found in individuals who reported “no knee pain” compared to those who did5.

What this means:

  • if you are in this age group and were found to have meniscal damage on an MRI, the meniscus may not necessarily be the source of your pain, and
  • you should seek clinical correlation with your Sports Medicine Doctor and attempt conservative management with a physiotherapist before considering surgical intervention.

 

LOW BACK PAIN – INTERVERTEBRAL DISC

Intervertebral discs sit between the vertebral bones of our spine, are made up of an outer fibrocartilage ring called the annulus, and are filled with a gel-like center.  They act to absorb and cushion forces between the vertebral bones. Abnormal disc findings on imaging are often interpreted as the cause of back pain. A recent systematic review found that it was common to find disc abnormalities in individuals who had no pain, and that these abnormal findings increased in prevalence with age.

Findings included6:

Pathology Prevalence in 20 year olds who report no back pain Prevalence in 80 year olds who report no back pain
Disc degeneration 37% 96%
Disc bulge 30% 84%
Disc protrusion 29% 43%
Annular fissure 19% 29%

HOW DO I KNOW WHO TO SEE?

It is important to have a detailed assessment with an appropriate health care practitioner in order to help you determine if the findings on imaging correlate clinically to your symptoms, or if there is a different reason for your pain. (Keep in mind imaging isn’t always needed and should only be used to confirm clinical findings.)

At Fortius, we have an integrated medical team who will work together with you to accurately diagnose your injury:

  • Sports Physicians & Specialists
  • Orthopaedic Surgeons
  • Physiotherapists
  • Chiropractors

We also have an integrated team who can guide the appropriate management of your injury rehabilitation:

  • Physiotherapists
  • Chiropractors
  • Massage Therapists
  • Pedorthists
  • Optometrists
  • Biomechanists
  • Physiologists
  • Dietitians
  • Performance Rehabilitation Coaches
  • Strength & Conditioning Coaches

Visit the Fortius Our Team page to learn more about our integrated practitioner team.

 

RESOURCES

  1. Hall MJ, Lawrence L. Ambulatory sur- gery in the United States, 1996. Advance data from vital and health statistics. No. 300. Hyattsville, MD: National Center for Health Statistics, August 12, 1998. (DHHS publication no. (PHS) 98-1250.)
  2. Englund M, Lohmander LS. Risk fac- tors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum 2004;50:2811-9.
  3. Hede A, Larsen E, Sandberg H. Partial versus total meniscectomy: a prospective, randomised study with long-term follow-up. J Bone Joint Surg Br 1992;74:118-21.
  4. Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br 1948; 30:164-70.
  5. Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT. Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons. N Engl J Med 2008;359:1108-15.
  6. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Am J Neuroradiol 2015;36:811–16.