Should We Scan Painful Hips?

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What’s the use of scanning or x-raying a painful hip or knee for that matter? If you’re a clinician or healthcare professional reading this, you will know that there is limited correlation between the ‘abnormalities’ we see on a scan and symptoms or pain that are felt. If you’re not in the health care profession, this may come as a surprise to you.

My Hip Hurts

You have a painful hip that just won’t shift, the pain that is, not the hip!  Surely if you can see the intra-articular structures (the structures inside a joint) then if we spot any defects or damage that should be the source of the pain ? THEREFORE, if you address or repair the damage somehow then you can rectify the problem and get rid of the pain, right…?
Not so fast…

Damage Doesn’t Equal Pain!

There are numerous studies and high quality reviews that have reported the prevalence of intra-articular hip pathologies in those who have no symptoms, meaning we can see ‘damage’ on the scans but the patient doesn’t report any pain.  A recent systematic review and meta-analysis by Heerey et al (2018) evaluated the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain by systematically evaluating all the high-quality published research on the topic – amounting to 29 studies that were eligible for inclusion. You’re probably predicting what I’m going to say here…

The prevalence of hip pathologies as identified on scanning/imaging was highly variable in both symptomatic and asymptomatic populations. This means pathologies, damage or abnormalities were present in people who had pain and in those who didn’t!

Why Bother Scanning?

If you’re sat there with a painful knee, or back, the message is the same – there is a very poor association between pain and image-diagnosed pathology. So, whilst you’re intuitively wanting a scan to prove what’s wrong, or waiting for the results before you commit to rehab, I’d invite you to think again.  Have you been offered, or really committed to focussed exercise therapy?  Have you talked to anyone about your pain?  We are complex beings and our perception of pain isn’t purely mechanical.  I wrote about this last time, see here for a further read.

Scans Are Useful..!

Used in the right way, scans, x-rays, images can be very useful, invaluable in fact. But not typically as a first line of investigation. I guess all I’m saying here is as a patient, of which I’ve been one several times(!), be open minded to alternative routes to remedy.  Don’t hold out for a scan and place all your eggs in that basket; you may or may not have pathology.  And in all likelihood in many cases these results will not influence how a physiotherapist treats you and the exercise they prescribe. Set yourself on a positive rehabilitation journey: think “recovery” not ‘damage’

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