What is Low Back Pain?
Pain in the low back can be from problems with any of the following: the spine, discs between the vertebrae, or the bony part of the spine, ligaments around the spine and discs, impingement of the spinal cord and nerves, sore muscles of the lower back, diseases of the internal organs of the pelvis and abdomen, or problems with the skin covering the back. Low back pain is usually not caused by something very serious. A very common cause of low back pain is strain of the muscles and ligaments. This type of low back pain is very common and usually gets better within a few days to a few weeks. Most people with low back pain don't need to have imaging tests or visit a specialist, nor do they usually need surgery.
What is recommended care for Low Back Pain?
People 18-50 with low back pain should not receive an imaging study (an X-ray CT scan, or MRI) within the first 28 days unless a “red flag,” which refers to a serious symptom or physical exam finding, is detected by their doctor. Here are some reasons why doctors are discouraged from recommending an imaging test too early in the process of your evaluation.
- Imaging tests have some risks. X-rays and CT scans expose your body to radiation. Over time, repeated exposure to radiation may increase your chance of getting cancer. Having an X-ray series of your lower back gives you about as much radiation exposure as 65 chest X-rays. Having a CT scan of your lower back gives you about as much radiation exposure as 165 chest X-rays. Since MRIs use magnets rather than X-rays, there is no risk from radiation. However, having metal objects or implants in your body (such as pacemakers, artificial joints, screws, stents, plates or staples) can be a serious risk and interfere with the test.
- For most cases of low back pain, an imaging test doesn't give doctors much information that's useful for diagnosis or treatment, because strain on muscles and ligaments do not show up on these tests.
- Medical research shows people with low back pain who get imaging tests do not recover any better or faster than those who do not receive them.
- Having an imaging test can lead to more care than you need — and expose you to more risks. Many things that show up on imaging tests are not serious and may not be the cause of your pain. However, once these things have been seen on a scan, there is a tendency to want to do something about it. Often, this results in more tests or procedures that can be harmful, such as back surgery.
What do the reports tell me?
About 67% of individuals with low back pain were not given unnecessary imaging tests as part of the evaluation of their symptoms. You can use the quality reports on this site to compare how often doctors’ office provided the right care for low back pain. Higher scores are better.