How To Move Without Pain

Do I need an x-ray if my joints hurt?

by Meghan Griech, PT, DPT, cert MDT, CKTP

This article takes 6 minutes to read

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Approximately 25% of adults will have knee pain at some point in their life. The pain may be from an injury, like a fall or a twisting movement. The pain could also develop slowly over time from changes in muscle strength, ligament stability, or the movement of the patella (kneecap) as the knee bends and straightens. Most of us will wait out the pain, hoping it goes away on its own with a little rest, a little medication, and a little icing.

When it doesn’t, that’s when we head to our family doctors, why not a physical therapist (PT)? (IMO, I’m not sure – I’m assuming it’s ingrained in us to go to our doctor with any ailment whether they can fix it or not.) Your doctor will assess your knee, listen to your pain complaints, and then send you off for an x-ray. “To see what’s going on inside’

X-rays are a form of electromagnetic radiation that can be used to see inside the body without surgery. The electromagnetic radiation works by passing through the body, and they show up on the other side as light or dark areas. X-ray machines use a computer to take pictures of what is inside your body, and then they print out these pictures on special sheets of film called x-ray films or x-rays.

 X-rays can detect bone fractures, bone alignment with other bones, certain tumors and other abnormal masses, pneumonia, some types of injuries, calcifications, and foreign objects. 

Imaging is important after a traumatic injury, like a fall downstairs or a car accident. Knowing whether a bone is fractured can be identified quickly with an x-ray. 

What happens when the results come back, and the report says osteoarthritis was found under your kneecap and mildly on the outside of your joint, but your pain is on the inside of your knee? That is when it gets really confusing for most; making the appointment, paying the co-pay, and arriving at another appointment. And it didn’t help you even find any answers to your questions, in fact, only leaves you with more questions.

An X-ray is like an Instagram post. – If you’ve never heard this analogy before,  keep reading and hear me out. 

Any completed imaging, whether an X-ray, MRI, or CAT scan, compares you to the gold standard. The radiologist will describe everything that is different in your joint from the standard they compare to, even if what they are finding is completely normal for your age, medical history, and activity level. It can feel like a laundry list of how your insides aren’t perfect and all that is wrong or changed in your body. On top of this, you never met your radiologist.  They don’t get to talk to you and take your history to find out what you complaints are.  All they get is an order to read the image they get.

Much like we compare our friend’s amazing vacation Instagram post to our own vacation. 

Are our memories as amazing as theirs? 

Is our vacation as amazing as we envisioned? 

Is my osteoarthritis the reason for my pain? 

Does my imaging explain why I’m in so much pain? 

Truth is, an image is never the whole picture of what is going on with your body.

In fact, sometimes an image can just make it more confusing.

Think of it this way – if you have a zing of pain from your back down your leg every time you sit in your car, but it doesn’t happen when you are laying on your back…. What is an X-ray or MRI showing when you are lying flat for the test? It could be related – or have no relation at all.

A good positioning technique is of great importance in radiology in order to obtain accurate diagnostic information and reduce the patient’s X-ray exposure. Yet that image just shows how you are different from the gold standard comparison. It doesn’t explain why you hurt.

If your knee hurts when you walk down a hill, then why don’t they take an MRI while you are walking down a hill? Take the image while you are in the activity that causes you pain.

(MRIs can’t be taken during movement or outside in the open, hence why it’s not an option)

So if it’s not OA, what could it be? 

📌 stiff joint
📌 muscle weakness
📌 irritated tendon
📌 bursae inflammation
📌 strained muscle
📌 stress inflammation 
📌 irritation of soft tissue around a joint, like plica
📌 poor movement mechanics
📌 instability of a joint due to weakness
📌 neural irritation 
I could keep going! 

An image doesn’t explain everything and neither does osteoarthritis when you have joint pain. That’s why understanding more about your pain can be more valuable than any image of your joint in many cases. 

First, think back to when your pain started. Was it after trying a new activity or doing something for a prolonged period of time, whether sitting in the car, walking or standing in a line. Do you or did you have any swelling or changes in your skin color? Have you figured out anything that make the pain better?  Is it a certain position, for example less pain when your knee is straight over bent, or walking over level ground versus up stairs. What makes the pain worse? Increases the pain intensity or changes the pain from an ache to a sharper pain? Does the location of the pain ever change? 

More details about the joint pain that you are experiencing, will not only give you but your medical professional more clues as to what tissues are involved in your pain.  The behavior of your pain can give guidance on whether it is a day that your joint needs more rest rather than an increase in activity or the opposite. 

*Disclaimer: All information in this article is intended for instruction and informational purposes. The author(s) are not responsible for any harm or injury that may result.  This information is used to supplement not replace any advice you were provided from your doctor or another medical health professional.  No guarantees of specific results are expressly made or implied with this article.

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