When should you get a scan? A real life case study
Imagine this: Midway through a long run you start to feel a pain in your glute. From then on, each run that you do you feel the pain, and it gradually gets worse. 3 months down the track, you see your health professional. Do you get a scan to find out exactly what it is? Or do you trust your health professional with their diagnosis and training/rehab plan WITHOUT a scan?
This is an ongoing question that athletes and health professionals are faced with when an injury presents. The reality is that there is no correct answer, and it always depends on the individual case. The decision to get a scan needs to be calculated based on many factors:
The perceived severity of the injury
The amount of change in management if the scan shows one diagnosis over another
The urgency of injury rehab for the athlete
The athlete’s preferences
The psychological effects of a scan
In recent times, there has been a shift away from premature and unnecessary scanning for every injury. This is because a lot of the time, getting a scan doesn’t necessarily change the management plan for the athlete, so then getting it will only be more $$ spent unnecessarily.
However, if there is any chance that the injury could be severe such as a stress fracture, nerve damage or major tears, then a scan is required immediately to ensure correct management and prevent further damage.
Another disadvantage of getting a scan can be the negative psychological effects it has on an athlete. There are plenty of times where scan findings can be inaccurate or show something that is considered by the athlete an abnormal presentation, but really may in fact be a normal physiological variation and unassociated with injury pain (Brinjikji et al, 2015; Register et al 2012). The ‘abnormality’ may have been present the whole time before the athlete started having pain, and can likely be also found in other individuals without any pain at all. But of course, when a scan reads ‘tear’ or ‘degeneration’ or ‘disc bulge’ (All of which may in fact be normal’), it’s no doubt going to play havoc on the athlete’s psychology, which can then affect the actual recovery progress.
A perfect example of this is the case I was describing at the very start of this blog. The runner I was seeing (Let’s call him Bob for today) had been experiencing glute pain that was gradually getting worse over 3 months. Upon examination, I diagnosed it as hamstring tendinopathy, and gave him a strengthening program to do while dropping down the running temporarily before building up again as tolerable. 3 months later, Bob had returned to 35km weeks and the pain was minimal, albeit not completely disappeared.
We decided to get a scan at this point to see if there was anything else I had missed and for Bob’s peace of mind. The scan showed an almost complete tear of the hamstring. Hearing this, Bob was completely rattled. I referred Bob for a second opinion with a Sports Physician and assured him that the scan was not reflective of Bob’s capabilities at all. After finding out the scan results, Bob’s pain got worse. Every run thereafter was much more painful than before, even though he had been doing these same sessions for the last few months with minimal pain.
Bob saw the sports physician a couple of weeks later, who also assured Bob that he was doing all the right things. The fact that Bob had been doing strength training all these months and had minimal pain was a good sign, so he could continue running and even build up to more distances and speed! Bob was stoked to hear this. And guess what? The day after his sports physician appointment, the pain became barely noticeable again. Now, Bob still has his hamstring tear, but is still running and almost in peak condition at his previous PBs again.
So what is there to learn about this? The negative psychological effects of getting the scan immediately escalated Bob’s pain. The pain also suddenly disappeared as soon as Bob was reassured and confident in his ability to run. Yet the hamstring tear was there the whole time! This shows that the scan findings do not always directly relate to pain levels and there is an association between the athlete’s psychology and their pain levels.
It also shows that scans are not always reflective of an athlete’s true function. Bob might as well not have a tear with the way he is running at the moment. So don’t see the scan define you. Your injury is not your destiny.
Yes or no?
Ultimately, the decision to get a scan rests on so many different factors. A combined decision between a health professional and the patient is paramount, after weighing up the benefits of the scan.
If you do choose to get a scan, keep in mind that a scan result is only one piece of information that needs to be put in context to form the big picture. Sometimes it adds up and makes sense, other times there is a mismatch of information.
If you are in a situation where you are wondering whether a scan would be of benefit, feel free to reach out to firstname.lastname@example.org to get a proper assessment and opinion. We are always happy to help!
Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations (2015). W. Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes, and J.G. Jarvik
Prevalence of Abnormal Hip Findings in Asymptomatic Participants: A Prospective, Blinded Study (2012). Brad Register, Andrew T. Pennock, Charles P. Ho, Colin D. Strickland, Ashur Lawand, Marc J. Philippon