Are you a VOMIT? VOMIT in this case stands for “victim of medical imaging technology”. Not sure how to answer this question? Have you ever been told you need to have an x-ray on your first visit to an office despite how you are clinically presenting as this is a “specific” protocol that every new patient must go through, been told you need your x-rays “updated”, or getting an x-ray is considered a part of their new patient “special” implying that it is going to be adding to your care. Far too often we hear that people have to go through these processes just to hear that they are broken, out of alignment, have scoliosis, degenerative disc disease, arthritis, disc herniations, stenosis, tendon tears, etc. Then stating that the doctor would like to see you 3 times a week for months or maybe even come back weekly for life in order to correct or manage these issues at best. This structure of care ultimately makes you lose independence of yourself and the issue at hand, and to build reliance on the doctor to do all the work to “fix” you and to keep you pain free. What if you found out that a large majority of the population of people have these very same “abnormal” findings but without pain, yes the same “abnormal” findings that you are being told are the reasons you are having pain and why you need to keep being seen to “fix” your pain.

As we dive deeper into this issue, there are a few major key points that people deserve to know. First and foremost, you can NOT image pain. Pain does not show up on an x-ray, MRI, or CT scan. Yes, abnormal findings do, but these are not always the sources of pain. When someone tells you, you have “ this or that”, it is not always the answer to your pain. It is impossible for someone to point to an image and say “that’s where the pain is”. An easy example is osteoarthritis. Many people think degenerative changes such as arthritis = DEATH SENTENCE TO PAIN. However, this is false and if anyone tells you otherwise they are misinformed. This is actually a normal response by the body in order to create more stability to a joint or region that was moving too much in the first place. Our bodies are designed to function in a proper manner and if not, our bodies will find ways to adapt. Another example is blaming pain on disc bulges, degenerative disc disease, or degenerative joint disease. Just because you have degrative changes on an image does not always mean you will have pain. Degenerative changes are actually a normal process as we age, starting at 20 years old!

There have been many studies that prove these things to be true. Examples from studies stating facts such as:

1.) In the lumbar spine (low back), 40% of individuals under the age of 30 years old have disc degeneration and over 90% of people aged 50-55 years old have the same findings all without pain.

2.) Another study has shown that 48% of people between 20-22 years old had at least one degenerated disc and 25% had a bulging disc, all without pain.

3.) In the cervical spine (neck), 98% of all men and women without neck pain have evidence of “degenerative changes”.

4.) In the shoulder, 20% of adults have partial rotator cuff tears, 15% have full tears, and in those older than 60 years old, 50% have rotator cuff tears, all in which do not have pain.

5.) In the knee, up to 85% of adults without pain had x-rays that showed arthritis, meaning there is little correlation between the degree of arthritis and pain.

6.) One study showed that 48% of professional basketball players had meniscal damage on an MRI, but were not experiencing any symptoms.

7.) In the foot and ankle, a study had shown that 32% of people without pain had heel spurs that were visible on their x-ray.

8.) In the hip, a study of hockey players showed that 77% of them had hip and groin abnormalities on their MRI, yet none of them were having any pain.

Medical imaging procedures such as MRI, X-ray, CT scans do have a time and place and can be very valuable for identifying conditions such as tears, fractures, dislocations, spinal cord and nerve related injuries, cancers, etc. They can help a clinician obtain more imperative information to a case. However, it is unnecessary to image a patient without a warranted reason, such as a history of trauma, accident, fall, red flags like a history of cancer, any neurological findings such as muscle weakness that is progressively getting worse, if a trial of conservative care either has no effect or is worsening the condition, etc. The majority of time, minor findings on images such as degenerative changes, arthritis, disc bulges, and tendon tears have little to no value in explaining the reason behind someone’s pain. The image itself (X-ray, MRI, CT) is not the issue, the issue is the education of the image and how it is described to the patient which can unfortunately at times create a lot of fear and have adverse psychological effects. Those who have been inappropriately managed in this sense usually end up having more doctor visits, longer lasting pain, greater disability, and an overall lower sense of health and wellbeing.

Again while images can be very crucial in specific cases, finding a trained clinician that knows when an image is warranted and when it is not will be of the best service to a patient. A clinician that also knows the truth about abnormal findings and their correlation to pain will also help further search and understand the root cause of the pain rather than treating what they see on an image. If you or anyone you know can relate to this topic or have further questions concerning this issue, Great Lakes Spine & Sport would be happy to discuss this further and give you more information.

So again, are you a VOMIT?