Should I Ask for a Scan?Understanding When Imaging Matters for Back Pain
- Dr Senadheera
- Jun 23
- 5 min read
Updated: Jul 6
"Can I have a scan to find out what’s causing my back pain?"
It’s a common question — and a fair one. If your back hurts, you naturally want answers. Scans like MRI or X-ray might seem like the logical next step. But in most cases, a scan isn’t the first tool clinicians reach for.
Here’s why — and what you can do to get the most out of your appointment.
Why Scans Aren’t Always the First Stop
About 85% of back pain is classified as non-specific. That means a scan might not pinpoint a clear source. That’s not a dismissal of your pain — it’s a reflection of how complex and multi-layered back pain can be.
Scans show us structure — not sensation.
You can have disc bulges, wear and tear, or other "changes" on your scan and still feel fine. Or you can have severe pain and nothing significant show up.
MRI scans often show structural changes that sound alarming but are part of normal ageing — and sometimes show up earlier than expected.
Over 80% of adults over 50 show disc degeneration on MRI — even without pain (1).
More than half of healthy people aged 15–30 have at least one disc change on MRI — often in the lower spine (2).
What this means for you:
Your scan is only part of the picture.
To make sense of it — and to make the right decisions — it needs to be looked at alongside your symptoms, your story, and how the pain is affecting your life.
So if you're told you have a "degenerative disc," it simply means the disc has some age-related changes — which are very common and don’t always cause pain. It’s a normal part of how our spines age, much like skin changing over time or hair turning grey.
This is why clinicians often wait before ordering a scan, especially if symptoms are mild or improving. It avoids false alarms, over-treatment, and the stress of hearing something that might not actually be a problem.
When Scans Are the Right Tool
There are clear times when imaging matters. MRI or CT scans may be needed to:
Investigate serious causes like cancer, infection, or inflammatory conditions
Confirm a fracture, especially following trauma
Assess sciatica or nerve pain that isn’t improving
Check for spinal stenosis, where narrowing in the spine affects movement
Rule out cauda equina syndrome, a rare but urgent condition
How Do Clinicians Decide When to Scan?
Clinicians use a combination of research-backed decision tools and look out for what are known as "red flags" — symptoms that suggest something more serious may be going on.
These RED flags include:
Unexplained weight loss
New weakness in a limb
Changes in bladder or bowel control
A history of cancer
But not every case is clear-cut. Some people fall into a GREY ZONE — where symptoms aren't obviously urgent, but they’re not going away either.
In these situations, the decision to scan depends on several factors:
How long the symptoms have been going on
Whether the pain is stable, worsening, or limiting your ability to function
Whether having a scan would change the plan — such as starting new treatment or referring to a specialist
If symptoms persist, become more disruptive, or don’t respond to early management, imaging may still be helpful — even without red flags — especially to help guide what happens next.
Key takeaway:
Scans aren’t only used to diagnose what’s going on — they’re also essential for planning the next step in your care.
This could mean choosing the right treatment, referring to a specialist, or preparing for surgery if needed.
A Good Scan Doesn’t Replace a Good Assessment
An image is just one part of the picture. Your clinical history, physical exam, and functional impact matter just as much — if not more.
Prepare for your appointment:
Write down what’s bothering you most — pain, fear of something serious, or functional changes?
Note patterns: what makes it better or worse?
Ask: “Would a scan change what we do next?”
This opens the door to a more meaningful discussion and helps your clinician tailor care to your specific needs.
Why Waiting Can Be the Right Call
We know waiting can feel frustrating — especially if you’re in pain. But here’s what clinicians are weighing up:
Will a scan change the plan?
Are there signs of something serious?
Is the problem improving with basic care?
Scans can sometimes show things that look worrying but aren’t causing your symptoms. Acting on these findings too quickly can lead to unnecessary medication, procedures, or even surgery (3).
Waiting isn’t the same as doing nothing. It’s often a sign your clinician is giving thoughtful, guideline-informed care based on what’s most likely to help — not just what’s quickest to order.
What If I’m Still Struggling and Not Getting Answers?
Back pain is exhausting — and when it lingers or disrupts your life, it deserves attention.
Even without a scan, there are things you can start today:
Stay as active as you can, without pushing too hard
Learn your triggers and limits
Use pacing and positioning to manage symptoms
Try medication, physiotherapy, or manual therapy if advised
Continue to advocate for yourself - Keep track of changes and follow up if symptoms worsen
These aren’t second-best steps — they’re evidence-based strategies supported by UK national guidelines (4) and often recommended by spinal surgeons before considering surgery or imaging.
Final Thoughts: Making the Best Use of Scans
Scans are a powerful part of spinal care — but they work best when used at the right time, with the right questions in mind.
You deserve to be part of that conversation.
At MamaGotBack, our goal is to help you feel more informed, more supported, and more confident in understanding what’s really going on — and what to do next.
✅ Key Takeaways
Most back pain doesn’t need a scan straight away — and often improves without it
Scans can show common changes that don’t always cause pain
A full assessment is essential before jumping to imaging
Red flags help guide when a scan is important
Your voice matters — be clear about your concerns and goals
Did this article help you better understand how doctors decide when to recommend a scan for back pain?
Yes, I now feel more informed
No, I still have questions
I'm not sure yet
I already understood this before reading the article.
References
Brinjikji W, et al. Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR. 2015;36(4):811–816.
Han C, et al. Prevalence of Intervertebral Disc Degeneration in Asymptomatic Young Adults: A Magnetic Resonance Imaging Study. World Neurosurgery. 2022;163:e124–e132.
Sajid IM, Parkunan A, Frost K. Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care. BMJ Open Qual. 2021;10:e001287.
National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59]. London: NICE; 2016.
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