Low back pain is one of the most common reasons why people visit their doctor or emergency care. Severe low back pain may be daunting and may lead you to think something is seriously wrong, But, as hard as it may be to understand, the majority of cases of low back pain are not serious and spinal imaging is not necessary. This is evident in figure 1.1 below which shows serious pathology is present in <1% of patients.
Figure 1.1: NSLBP vs serious pathology (NPS MedicineWise, 2018).
According to SA Health, current guidelines for LBP recommend against routing imaging such as x-rays or magnetic resonance imaging (MRI) or computerised tomography (CT) in the absence of red flags in non-specific low back pain with less than 12 weeks’ duration (SA Health, 2022)
When you visit your physiotherapist they will conduct a thorough examination in order to determine the presence of clinical red flags. “Red flags” alert your health care provider to potential sinister pathologies where imaging may be appropriate. These red flags include:
- A history of cancer.
- Unexplained weight loss.
- Recent infection.
- Loss of bowel or bladder control.
- Abnormal reflexes, or loss of muscle power or feeling in the legs.
Take home message
Majority of people with LBP feel better within four to six weeks and often sooner, whether imaging is done or not. Unnecessary imaging has been associated with adverse health outcomes, such as effects on disability, healthcare costs and sense of wellbeing.
NPS MedicineWise. 2018. Low back pain – do you need a scan?. 1st ed. [ebook] Sydney: NPS MedicineWise. Available at:
Sahealth.sa.gov.au. 2022. Spinal imaging recommendations | SA Health.