Do I Need a Scan? When Imaging Is (and Isn’t) Necessary for Pain

One of the most common questions we get at Body Fit Physiotherapy North Adelaide is:“Should I get a scan for this?”

Whether it’s back pain, knee discomfort, or a sore shoulder, many patients understandably assume that an X-ray or MRI is the first step. But the truth is, scans are often unnecessary – and in some cases, they can actually cause more harm than good.

In this article, we’ll explore:

• When scans are helpful

• When they’re not

• What you should do instead

• What a physiotherapist can diagnose without one

📸 Why People Want Scans

It’s normal to want answers when you’re in pain. Scans like X-rays, MRIs, and CTs seem like a quick fix to identify the “problem.” But research shows scans often:

• Show things that are not causing your pain

• Miss the actual cause (e.g. muscle or nerve issues)

• Increase anxiety if they show “degeneration” or “disc bulge” (even if these are normal findings)

🧠 What the Research Tells Us

Several studies show that imaging findings don’t always match pain:

• Back Pain: MRI studies show that up to 80% of pain-free adults have disc bulges or degeneration (Brinjikji et al., 2015).

• Knees: Meniscal tears are found in 60% of people over 50 — even with no pain (Englund et al., 2008).

• Shoulders: Rotator cuff tears are found in up to 65% of adults over 70 — again, many are pain-free.

This tells us that age-related changes are normal and not always a cause for concern.

✅ When Scans Are Useful

At Body Fit, we only recommend scans when:

• We suspect a fracture, dislocation, or serious pathology

• Symptoms are not improving with treatment

• There are signs of nerve compression with weakness or loss of bladder/bowel control

• We need to confirm a specific surgical decision

We work closely with local GPs, sports doctors and orthopaedic specialists to guide imaging only when clinically necessary.

❌ When You Don’t Need a Scan

You likely don’t need imaging if:

• Your pain is musculoskeletal (e.g. from muscle, tendon, joint)

• It came on gradually or with overuse

• You can move, even if it’s painful

• Symptoms change with activity or rest

In these cases, physiotherapy assessment and rehab are the gold standard first steps.

🧑‍⚕️ How Physiotherapists Assess Without Scans

At Body Fit, our physio-led diagnosis involves:

• Thorough history to understand mechanism and symptoms

• Hands-on assessment of joint movement, muscle strength, and nerve function

• Functional testing to replicate pain patterns

• If needed, we may use movement screening, ultrasound, or refer for further investigation

We’re trained to detect red flags and identify if your symptoms are safe to treat, or need onward referral.

🧭 What to Do Instead of a Scan

1. Get a physiotherapy assessment early

2. Understand your pain – what structures are involved and why

3. Start an active treatment plan – guided movement is better than rest

4. Track improvement over time, not just scan results

🧘‍♀️ What About Degeneration or Arthritis on My Scan?

Here’s the thing: degeneration doesn’t mean damage. In most cases, it means normal age-related change — like wrinkles on the inside. Our bodies adapt over time, and most “wear and tear” isn’t painful.

Treatment focuses on strength, flexibility, and movement, not avoiding use.

💡 Key Takeaway

🔹 Scans are not the gold standard for most pain

🔹 A thorough physio assessment is often more accurate and helpful

🔹 Getting moving sooner leads to better recovery

If you’re in pain and wondering if you need a scan, start with us at Body Fit Physiotherapy. Our team will help you make the right decision — based on the latest evidence and your unique presentation.

📍Book Your Physio Assessment Today

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📍 Serving North Adelaide, Prospect, Walkerville, Medindie & surrounds

📞 Call us or Book Online for expert advice and personalised treatment

📚 References:

• Brinjikji W et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol.

• Englund M et al. (2008). Meniscal tear in knees without symptoms. NEJM.

• Deyo RA, Mirza SK, Turner JA, Martin BI. (2009). Overtreating chronic back pain: time to back off? J Am Board Fam Med.