We all know that Instagram pictures don’t exactly show reality of life. Instagram flaunts carefully crafted accounts that portray a certain image. It’s not a lie, but it’s definitely not the whole truth. For example, a smiley selfie on the beach that fails to show a stressful week at work. Instagram has highlighted to us that pictures aren’t always a reliable portrayal of reality. We argue that the same is true for medical imaging- x-rays, ultrasounds, MRI, etc.
Before we unpack that, let’s just stress that medical imaging has improved modern healthcare and, subsequently, care received. It’s been an invaluable tool ever since it’s accidental discovery by Wilhelm Roentgen in 1895. Since it’s discovery there have been leaps and bounds made in quality of imaging, skills and knowledge. Imaging has literally saved lives, detecting cancers, infections and foreign bodies. When used appropriately, there is absolutely no doubt of its benefit! But a dependence on imaging and the current trend to overuse imaging is potentially harmful and needs to be questioned.
We at Sports Lab are highly trained professionals in musculoskeletal injuries. We know what normal and abnormal findings are. The range of hands on assessments available allow us to form a clear picture of what’s going on underneath the skin even if we can’t see it with our eyes. If we can diagnose without imaging why do we need to order routine imaging just to tell us something we already know? Not only does it mean unnecessary financial cost but it also puts stress on a busy healthcare system. Some clinicians argue that imaging can be useful for reassuring their clients, but evidence suggests that when imaging is used without clinical indication it actually increases fear and angst, not reassurance.
But apart from being purely inessential at times, medical imaging can also fail to explain why some things hurt. Many people understand pain as a direct response to a stimulus- you break your leg, this will no doubt hurt and cause discomfort. But what if this bone heals but you continue to experience pain in the leg. What then?
There are multiple research studies showing results from medical imaging which are considered pathological in subjects with NO pain or dysfunction. One study done by Grisih and his colleagues in 2011 performed ultrasound assessments of the shoulder on 51 males with no past or present pain in their shoulders. A staggering 96% of these subjects had at least one so-called pathology found. There are even studies reporting certain pathological findings MORE COMMONLY in pain-free subjects than in those experiencing pain and discomfort. Let that sink in a little bit.
So now what?
So just because imaging shows that a structure is worn, torn or out of place, it doesn’t mean that this structure needs treatment. Medical imaging should not be used as a stand-alone diagnostic tool. Imaging results need to be viewed alongside a thorough subjective assessment and hands on assessment. In other words, we never treat the imaging result. Instead we use imaging as a helpful tool to contribute to our clinical knowledge on a person and treat the person.
Clearly medical imaging plays an important role in healthcare, but it needs to be used wisely. Keep an eye out for further posts which will help build an understanding of why a painful structure might not be injured or an injured structure might not be painful.
About the Author: Hannah Cerecke is a Sports Lab Podiatrist and in-house bike-fitter. Hannah has a firm belief in the importance of holistic care and the benefit of multi-disciplinary management. She assesses not only the foot but takes into consideration whole body movement and lifestyle factors.