Generally, no. Rates of spinal imaging are high, with approximately 20-25% of people with back pain receiving a referral (1). This is despite guideline care recommending against this (1), as inappropriate referrals and subsequent misinterpretation worsen clinical outcomes (2). Why?

1. Musculoskeletal pain is an unreliable indicator of tissue damage observed in imaging (3, 4). Therefore, it adds little to no insight into treatment.
2. Moreover, non-anatomical factors contribute significantly to people's pain experience and course of recovery. Our feelings, expectations, and beliefs about our bodies can directly influence pain severity and recovery times (5).
3. Additionally, most clinicians struggle with interpreting scans and communicating effectively with patients, often teaching harmful ideas such as “You have the spine of a 70-year-old,” “You shouldn’t lift more than 10kg or flex your spine,” or “You should be in a lot more pain than you are.” This overwhelmingly leads to pain-related fear, amplifying the pain experience (6). Furthermore, it disincentivizes Physiotherapy, as it involves exercise, likely reducing the chance of successful treatment if these false claims cannot be convincingly debunked.

Radiculopathies are most commonly blamed on a herniated disc crushing a nerve root. Although logical, herniated intervertebral discs are very common in those who don’t have pain and don’t go on to develop any (7). The majority of herniations heal. Interestingly, the “worse” or bigger they are, the more likely they are to heal. The size of the herniation is a poor indicator of pain or radicular symptoms (8, 9, 10). This isn't to say scans have absolutely zero relationship, but it’s quite weak and underwhelming. This suggests these symptoms are caused by more than just one singular anatomical cause.