Medical Imaging: Friends or Foes of Health Care?
In the management of musculoskeletal disorders, the use of medical imaging is increasingly frequent.
They are now present in most of the care pathways taken by patients. They even sometimes constitute the central pillar of the diagnosis made by the medical profession and govern the treatment plan that follows. Medical imaging is, for example, an x-ray, an ultrasound, a scanner, an MRI (to name only the frequently used ones, etc.).
Although extremely useful for detecting serious medical conditions (fracture, cancer, spinal cord injury), they have no value in explaining the vast majority of classic musculoskeletal disorders. Most imaging findings are harmless and unrelated to the symptoms present in patients. These findings are now considered normal and part of the natural aging process of our tissues.
Here are some signs frequently found in healthy people with no symptoms:
– Neck: 98% of perfectly healthy adults show degenerative changes in their cervical discs
– Shoulder: 50% of people over 60 have one or more tendinous tears without it bothering them in everyday life. 40% of professional baseball players have a partial or complete torn tendon without even knowing it and without it preventing them from performing.
– Lumbar spine: we find the same proportion of herniated disc in the groups of healthy subjects compared to symptomatic subjects. Healthy people with a herniated disc will not necessarily develop back pain. 66% of herniated discs resolve/disappear spontaneously!
– Knee: 85% of adults without any physical problem have osteoarthritis and 76% have meniscal lesions.
We now consider that the changes found in our body are normal and part of the natural aging process of our tissues, just like white hair or wrinkles on the skin, without this being linked to any pathology.
“Wanting to fight a monster, we created another monster”
The medical progress made possible by imaging technologies is certain! It is a valuable tool for highlighting serious pathologies requiring rapid and very specific care as mentioned above. However, the drifts related to its overuse and to the erroneous interpretations concerning its results led to new problems. In addition to being irrelevant, most imaging results are also sources of psychological and physical harm. The frequent use of imaging is directly related to the number of medical appointments made, the persistence of pain, the degree of disability and a low sense of well-being. This phenomenon is called VOMIT among our Anglo-Saxon colleagues “Victim Of Modern Imaging Technology”.
By giving more importance to the history of our patients and their symptoms more than to imaging results: we have the potential to improve our care, make the therapeutic alliance stronger, be more specific to needs of our patients and above all to reassure them.
“Effective reassurance is a bloody good pain killer” Louis Gifford.”
We care, U perform.
Cet article est basé sur l’infographie « Concerned About Your X-ray or MRI Findings ? » de l’Advanced Physical Therapy Education Institute » ainsi que celle d’Anthony Halimi « Votre douleur ne se résume pas à une simple imagerie ».