When you hurt your back (or ankle, or wrist) and head to the doctor, should you expect an x-ray? In my last post, I mentioned that the only way to be certain whether or not a bone is broken is with imaging, and that is true. However, not every painful joint NEEDS to be x-rayed. I find that many patients are surprised or disappointed if I do not insist on an x-ray for an acute injury, but they are simply not always necessary, and radiation is not without harm.
XRAYS look at bones. They do not "see" cartilage, muscles, tendons or ligaments, though sometimes distance between bones suggests lack of cartilage. The vast majority of injuries that send patients to their doctors are not from broken bones, but strains and sprains and spasms of muscles and supporting tissue. (As a quick aside, a SPRAIN happens to ligaments, the tissue that attaches bone to bone. A STRAIN occurs in muscles or tendons (tissue connecting muscles to bones.)
As we try to limit both unnecessary radiation and expense, the world of medicine is taking a closer look at when interventions such as taking x-rays are really needed to improve patient outcomes. Medical centers are developing guidelines for different injuries that help physicians determine when an xray is truly needed, such as the Ottowa rules for ankle injuries. Stay tuned for more on those rules in my next post.)
RICE: Rest, Ice, Compression and Elevation (plus a bit of pain-reliever/anti-inflammatory medicine such as ibuprofen) go a long way towards treating injuries. Your doctor can show you the best way to compression wrap an extremity, plus possibly prescribe muscle relaxants or stronger anti-inflammatory medicine. Perhaps most importantly, your doctor may prescribe PHYSICAL THERAPY- where you will learn strengthening, flexibility and stability for your injury to fully rehab.
BOTTOM LINE: XRAYS are helpful diagnostic tools for bone injury, but don't assume your treatment of an injury isn't complete without one!