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It is time to stop causing harm with inappropriate imaging for low back pain
  1. Ben Darlow1,
  2. Bruce B Forster2,
  3. Kieran O'Sullivan3,
  4. Peter O'Sullivan4
  1. 1Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
  2. 2Faculty of Medicine, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3University of Limerick, Ireland and Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  4. 4School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Dr Ben Darlow, Department of Primary Health Care and General Practice, University of Otago, 23 Mein Street, Newtown, Wellington 6021, New Zealand; ben.darlow{at}

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Inappropriate imaging for low back pain (LBP) can cause harm in three ways:

  1. Misinterpretation of results by clinicians resulting in unhelpful advice, needless subsequent investigations (downstream testing) and invasive interventions, including surgery;1

  2. Misinterpretation of results by patients resulting in catastrophisation, fear and avoidance of movement and activity, and low expectations of recovery;2

  3. Side effects such as exposure to radiation.3

Problems associated with excessive imaging for LBP are well recognised ( and useful evidence-based guidelines have been developed to help clinicians determine when investigation is appropriate.3 However, currently, 42% of patients with LBP receive an X-ray, CT or MRI within 1 year of diagnosis, and of these, 80% receive imaging within 1 month of presentation.4 The uptake of imaging guidelines is likely to be similarly insufficient among the sports medicine community, where lumbar imaging is frequently used.

As well as recognising when imaging is appropriate, evidence-based reporting and interpretation of imaging findings is critical. The contents of …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.