Do You Really Need a Scan for That Pain? What the Latest Science Says

When Scans Work Well

Imaging is most effective when the goal is to confirm a specific structural issue. For example, fractures show up clearly on X-rays, while ligament tears and disc problems are typically well visualised on MRI scans.

In fact, a 2023 systematic review published in The BMJ found that MRI scans had a sensitivity rate of over 90% for diagnosing ACL tears, and over 85% for meniscal injuries (Smith et al., 2023). Likewise, a 2024 review in Radiology noted that musculoskeletal ultrasound achieved accuracy rates of up to 95% for diagnosing rotator cuff tears, though this often depends on the skill of the operator (Chen et al., 2024).

So, when there’s a clear reason for imaging, like a sports injury or suspected fracture, scans can be incredibly helpful in confirming what’s wrong and guiding treatment.

The Problem with “Incidental Findings”

Where imaging becomes tricky is in chronic or unexplained pain, especially when symptoms don’t clearly point to a single source. Many scans reveal “abnormalities” that are actually common in people without any symptoms at all.

For instance, a well-known study published in The New England Journal of Medicine (Brinjikji et al., 2015) showed that signs of spinal disc degeneration appear on MRI in 30% of people in their 20s, and as many as 84% of people in their 80s, many of whom have no back pain at all.

A similar study from 2008 found that meniscal tears were present in about 35% of adults over 50 who had no knee symptoms at all (Englund et al., 2008). These findings remind us that just because something shows up on a scan doesn’t mean it’s causing pain or needs treatment.

When Imaging Might Do More Harm Than Good

This leads to an important point: unnecessary imaging can actually be harmful. Several medical guidelines, including those from the American College of Physicians and NICE (UK), advise against routine imaging for things like uncomplicated low back pain. That’s because it often leads to a cascade of additional tests or treatments that may not be necessary.

A 2022 article in The Lancet Rheumatology pointed out that early or excessive imaging can reinforce fear in patients, leading them to avoid activity, which in turn can make the pain worse and delay recovery (Maher et al., 2022).

In short, imaging should be used thoughtfully, not as a default first step in every case of pain.

The Role of Osteopathy in Diagnosis and Treatment

This is where osteopathy can play a crucial role, especially when imaging doesn’t tell the whole story.

Osteopaths are trained to assess the body holistically. Through detailed case history, observation, and hands-on examination, they can often uncover patterns of tension, movement dysfunction, and postural habits that may be contributing to a patient’s symptoms.

For example, in cases of chronic lower back pain:

• An osteopath might identify restricted movement in the pelvis or spine.

• They may find muscle imbalances or tension patterns that aren’t visible on a scan.

• They often explore how other areas, like hip mobility or thoracic stiffness, may be putting strain on the lower back.

Treatment typically involves a combination of techniques such as soft tissue massage, joint mobilisation, and corrective exercise, all tailored to the individual.

Importantly, osteopaths also help patients understand their condition. Education and reassurance are powerful tools. In fact, current guidelines for back pain state the importance of remaining active and avoiding fear-based avoidance of movement, something osteopaths are well-positioned to support.

A Complementary Approach

That’s not to say imaging doesn’t have a role, it absolutely does. But it’s most effective when used as part of a wider diagnostic strategy. Think of scans as showing the “structure,” while osteopathic assessment reveals how that structure is functioning in real life.

A person might have a minor disc bulge on an MRI, but the real issue could be muscle tightness, poor core control, or movement habits. Without a hands-on assessment, these contributing factors are easily missed.

The Future of Scans: Smarter Imaging with AI

The good news is that the field is evolving. New technologies are being developed that may help clinicians make better use of imaging.

Artificial intelligence, for example, is starting to assist radiologists by analysing images more efficiently. A 2024 study in Nature Medicine found that AI models were able to match or exceed the performance of human radiologists in identifying the progression of osteoarthritis in knee X-rays (Zhou et al., 2024).

There’s also growing interest in imaging methods that go beyond static pictures. Functional MRI, elastography, and even inflammation-tracking scans are being explored to give a more complete picture of what’s really happening inside the body.

So, Are Scans Effective?

The short answer: yes, but with some important caveats.

Scans can be incredibly useful when there’s a clear clinical reason to use them. They’re great for confirming specific injuries, ruling out serious conditions, or planning surgeries. But they’re not magic. In many cases, especially for chronic or vague pain, imaging might not provide clear answers and could even complicate the diagnostic process.

Ultimately, the most reliable diagnoses come from a combination of patient history, physical examination, and imaging, when appropriate. Scans should support clinical judgment, not replace it. So if you are debating whether or not you should have a scan, come and consult your local Osteopath first. We will give you clear guidance on whether a scan is right for you!