CSA Physio Blog

How Do I Know if I Need an Xray?

Posted on: April 20th, 2019 by Lindsay Walker

Did you know that in Alberta, physiotherapists who have taken the required training have the ability to request xrays, MRI, or ultrasound imaging for their clients? Often this can be helpful in determining the appropriate treatment and can help rule in or out certain conditions.

How do you know if you need imaging?

There are some well established guidelines that can help determine if imaging is necessary. The Ottawa Ankle / Ottawa Knee rules, and the Canadian C-Spine (neck) Rules are examples. If you meet certain criteria, then x-ray imaging is recommended.

Each decision to recommend imaging is made on an individual basis, but here are some key things to consider:
1) How long have you been attending physiotherapy (or other) treatment? Have you been in treatment for longer than three months without any significant change? Are symptoms worsening?  Imaging may help determine what change to treatment or other intervention is necessary.
2) Are you experiencing neurological signs (weakness, loss of sensation or reflexes)? Imaging may help determine the cause of this.
3) Did you experience trauma where an initial radiographic report was normal? Your physiotherapist may help you to determine whether something was missed initially that needs a closer look.

Avoiding unnecessary imaging is important.  Although we are exposed to a natural amount of radiation during our daily lives (water, air, vegetation), radiation can cause mutations in DNA which can lead to cancer. CT scans and nuclear imaging give us the highest amount of radiation, but even repeated x-rays can be harmful long term. The key is not to expose any client to unnecessary radiation.

Importantly, sometimes what shows up on an x-ray report may not correlate to the pain or loss of function you are experiencing. For example age-related degenerative changes often sound like big, scary words on an x-ray report, and often have little to no impact on your actual condition.

Further questions? Make sure you talk to your physiotherapist.  They are your bone and joint rehab experts.

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