Imaging for low back pain

Choosing Wisely Recommendation: Don’t do imaging for lower-back pain unless red flags are present.

Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging of the lower spine before six weeks does not improve outcomes.

*Recommended by the College of Family Physicians of Canada/Canadian Medical Association and the Canadian Association of Radiologists

Why is it important?

X-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI) scans for lower-back pain rarely show the cause of the pain and can harm patients when there are no indications of serious underlying conditions. Apart from exposure to radiation, harm from unnecessary testing may include further avoidable tests and surgery. Evidence shows that acute lower-back pain generally goes away within 4 weeks, with or 4 without imaging. (CIHI, 2017)

Patient Resources:

Imaging Tests for Lower Back Pain: When you need them and when you don’t

Treating Lower Back Pain: How much bed rest is too much?

New Brunswick Inter-professional Spine Assessment and Education Clinics (ISAEC):

NB-ISAEC is a specialized low back pain triage and assessment clinic pilot program, located at the Saint John Regional Hospital and The Moncton Hospital.  This pilot program was created to assess and manage low back and/or low back-related leg pain, and provide patients a thorough assessment by specially trained physiotherapists.


  • engage patients, to self-manage their musculoskeletal issues.
  • provide timely access to primary and specialized care through an improved triage and assessment system by specially trained physiotherapists.
  • provide educational training on enhanced low back pain assessment and management skills for health care providers

Of the patients assessed to date, only 3.3% were recommended for further follow up with a surgical specialist. 75% of patients reported doing their exercises either daily or between 4-6 days per week with notable improvements on their overall disability scale.

The pilot program has approximately 85 primary health care providers who have taken the on-line learning program and are now able to refer to the clinic. We have capacity to have more physicians referring patients.  If you are a HC provider with the SJRH or TMH, please contact us at for more information on how you can refer your patients to the clinic