Why delaying imaging for acute low back pain matters.

Evidence supports conservative care before ordering imaging

A recent claims review of Martin’s Point Health Plan members showed that acute low back pain (LBP) is a common complaint, particularly among women. The current evidence suggests waiting at least 28 days before pursuing diagnostic imaging in most cases of acute LBP, as a rush to order imaging can be detrimental.

Why delay imaging?

• Most acute LBP improves with conservative care: Most cases (usually caused by muscle strains or sprains) improve with rest, physical therapy, and pain management—no imaging required.
• Imaging may lead to overdiagnosis: Imaging often reveals incidental findings (e.g., disc bulges or arthritis) that are not clinically significant, leading to unnecessary treatments and patient anxiety.
• The body often heals naturally: Within 28 days, most patients recover without imaging. Allowing conservative treatment time to work helps avoid unnecessary interventions.
• Imaging adds costs and risks: Premature imaging exposes patients to costs and risks (e.g., radiation exposure) without improving outcomes.

When to consider imaging

• Symptoms persist or worsen after 28 days.
• Neurological deficits appear (e.g., leg weakness).
• Red flags for serious conditions arise (e.g., fractures, infections).

Delaying imaging in acute LBP promotes better outcomes by reducing overdiagnosis, unnecessary treatments, and costs. Prioritize conservative management for the first 28 days and reserve imaging for cases where it is truly needed.