When to Image? A Physio’s View on Scans

One of the most common questions we get at Up N Adam Physiotherapy in Newcastle is:

“Should I get a scan for this pain?”

Whether it’s an MRI for a sore back, an X-ray for a knee injury, or an ultrasound for a tendon, imaging can feel like the logical next step. But scans don’t always tell the full story — and sometimes, they show things that aren’t even the problem.

Here’s how we guide patients on when imaging is useful, and when movement assessment is more important.

When Scans Are Helpful

There are definitely times when an MRI, X-ray, or ultrasound is needed. These include:

• Red flag symptoms – unexplained weight loss, fever, night sweats, or sudden severe neurological changes

• Significant trauma – e.g. suspected fracture, dislocation, ligament rupture

• Surgery planning – ACL reconstruction, meniscus tears, hip labrum injuries

• When progress stalls – if pain doesn’t improve despite appropriate management

In these cases, imaging provides critical information for your medical and physio team.

When Scans May Not Add Value

For many common musculoskeletal problems, scans are not the first step.

Examples include:

• Low back pain – most people show age-related disc or joint changes on MRI, even if pain-free

• Tendon pain – ultrasound often shows “wear and tear” changes that don’t match pain levels

• Knee osteoarthritis – X-rays may look severe, but symptoms vary widely between people

Relying only on scan results can be misleading — and sometimes increases worry unnecessarily.

What We Do First

At Up N Adam Physio, our focus is on:

• Thorough history taking – when it started, aggravating factors

• Physical assessment – strength, flexibility, control, and movement testing

• Objective measures – VALD dynamometer or force plate data to track function

This helps us understand whether the problem is structural (scan needed) or functional (scan not required).

Why “Treat the Person, Not the Picture” Matters

Research shows that many people have abnormalities on scans without symptoms:

• Up to 70% of adults over 40 have disc bulges on MRI with no pain.

• Shoulder scans often reveal rotator cuff “tears” in people who can move pain-free.

That’s why we treat you, not your image.

FAQs

Q: Can I request a scan without seeing my GP?

In Australia, most scans require a GP referral to be covered by Medicare. Physios can recommend when a scan is appropriate.

Q: What if my scan shows arthritis?

Arthritis is common and doesn’t always mean surgery. Strength and movement strategies often help.

Q: Should I always get a scan before physio?

No. Most musculoskeletal pain improves with assessment and rehab — scans are a backup if needed.

Call to Action

If you’re in Newcastle and unsure whether you need a scan, our physio team can assess you first and guide whether imaging is necessary.

This is APA Sports Physiotherapist, Darren Glendenning, signing off for now!

You can book an appointment with Darren or Newcastle Knights Physiotherapists Katie or Hayd'n at www.upnadamptphysio.com .

Bookings also available on our website for the following services at Up N Adam Performance Training & Physiotherapy:

• Dietitian - Sweat testing, weight-loss or to optimise your training nutrition / fuelling www.nutrientnation.com.au

• VO2 Max testing with Lucas McBeath - to discover more effective ways to train efficiently www.flowitri.com.au

• Strength & Conditioning Programs with Adam Clarke - contact us or book via the website or email us at upnadamptphysio@gmail.com

• Remedial Massage with Katheryn Rodgers - to relieve accumulative muscle tension & keep you training well.

• CycleFit by Physiotherapist Dean Waterman - At Up N Adam, for all your bike fitting solutions www.cyclefitphysio.com