If you have been trying to get an MRI scan through the NHS and finding the wait frustrating, you are not alone. Across Sussex, and across England more broadly, waiting times for diagnostic imaging have stretched considerably in recent years. For anyone living with back pain, neck pain or a persistent joint problem, that wait can feel very worrying. It is natural to assume that without a scan, nobody can properly understand what is going on or help you get better.
The good news is that for most musculoskeletal (MSK) problems, which include the vast majority of back, neck, hip, knee and shoulder complaints that bring people to a clinic, a scan is rarely the essential first step that most people imagine it to be. In fact, a thorough clinical assessment by a trained physiotherapist or chiropractor will often provide more genuinely useful information about your condition, your recovery and what to do next.
This article explains why, what a modern MSK assessment actually involves, when imaging is genuinely important and what you can do to start moving forward with your care right now.
The Scale of the Problem
The NHS has not met its six-week diagnostic standard for imaging since November 2013. According to the Royal College of Radiologists, in September 2025 more than 1.7 million people were waiting for a diagnostic test in England, with approximately one in four waiting longer than six weeks. Demand for CT and MRI scans is growing at more than twice the rate of workforce growth.
For people in Sussex, these numbers translate to significant delays, sometimes of weeks, sometimes considerably longer, for people who are uncomfortable, worried and uncertain about what is happening to their body.
For most common MSK conditions, however, an MRI scan is not where good care should begin.
The “Scan First” Trap and Why It Rarely Helps
There is an understandable but mistaken chain of logic that many people follow when they develop pain: Pain must mean something is damaged → something damaged means I need a scan → a scan will show what is wrong → then I can get treatment. It feels logical.
Unfortunately, it does not reflect how musculoskeletal pain actually works.
The largest and most-cited body of research on this question comes from systematic reviews of MRI findings in people who have no pain at all. A landmark systematic review by Brinjikji and colleagues, published in the American Journal of Neuroradiology (2015), analysed MRI scans of asymptomatic adults and found that disc degeneration was present in 37% of 20-year-olds, rising to 96% of 80-year-olds. Disc bulge was found in 30% of people aged 20, rising to 84% of people aged 80. These are people with no symptoms whatsoever.
What this means is that if you are in your fifties or sixties and you have an MRI scan, it is likely to show something: disc bulge, some degeneration, minor joint changes. But there is a strong chance that these findings were already there before your pain started and may well be unrelated to your current symptoms.
This is not a fringe view. The Academy of Medical Royal Colleges, through its Evidence-Based Interventions programme, states that routine imaging for low back pain frequently identifies abnormalities that are common in people without pain, and that this can lead to unnecessary distress, additional investigations and delays in starting effective care.
Rather than helping, a scan in this situation can send patient and clinician alike down an unhelpful path, investigating findings that may be incidental rather than treating the person in front of them.
What NICE Says and Why It Matters
The National Institute for Health and Care Excellence (NICE) is the body that sets evidence-based guidance for clinical practice in England. Its guideline on low back pain and sciatica (NG59 2020) is unambiguous: imaging should not be routinely offered for people with low back pain, with or without sciatica.
This is not because scans are unimportant. It is because, for most people presenting with back pain, the evidence shows that imaging does not change the treatment and that treatment started without a scan usually works just as well.
NICE recommends that people with low back pain are assessed using a structured approach that considers the nature and severity of the problem, the likelihood of a good outcome and whether any features are present that would warrant further investigation. This process, known as clinical triage, is exactly what our physiotherapists and chiropractors here at Sundial Clinics are trained to do.
What Happens During a Thorough MSK Assessment
If you have not seen a physiotherapist or chiropractor before or have not been to one for some years, it is worth knowing that a modern evidence-based assessment involves considerably more than asking “where does it hurt?” A good initial assessment at a multidisciplinary clinic like Sundial typically covers several areas:
Your history in detail. When did this start? What makes it better or worse? Have you had anything like this before? What does it prevent you from doing? How is your sleep, your activity level, your general health? These questions are not small talk: the answers often point more reliably to the nature of a problem than any imaging finding.
Screening for red flags. The most important job in an initial assessment is to identify whether anything serious might be causing your symptoms. Red flags (signs that could indicate fracture, infection, cancer, or conditions such as cauda equina syndrome affecting the nerves to the bladder and bowel) are carefully screened for during every assessment. If any of these are suspected, the right action is urgent referral for imaging and medical review. Most people do not have red flags but the systematic check matters.
Neurological assessment. If there is any suggestion that a nerve is being affected (for example, sciatica, pins and needles or weakness in the limbs), a careful neurological examination will help determine whether imaging is needed and how urgently.
Movement and physical assessment. How you move, where your range of motion is limited and how your body responds to particular movements tells an experienced clinician a great deal about what structure is likely to be contributing to your pain and how irritable or settled it is. Here at Sundial, if you present with back pain, we will feel each joint of your spine and all the spinal muscles checking for dysfunction that might be the cause of your problem. This is vital to understanding what the best treatment should be.
A broader picture. Contemporary MSK practice recognises that recovery from pain is influenced not just by physical factors but by a wide range of other elements: your activity levels, sleep, work situation, stress and beliefs about what the pain means. An umbrella review of systematic reviews by Alvarez Bustins and colleagues (2022) found consistent evidence that factors including high emotional distress, poor sleep and negative recovery expectations were associated with poorer long-term outcomes from low back pain. A good clinician asks about these, not to be intrusive but because addressing them may be as important as any hands-on treatment.
Whether imaging is actually needed. At the end of a thorough assessment, the clinician will have a clear picture of whether imaging is likely to add anything meaningful to the management plan. The guiding question is a practical one: would the result of a scan change what we do? If the treatment plan would be the same regardless (exercise, rehabilitation, education and progressive activity), then imaging is unlikely to help and the clinician can say so with confidence. If there is genuine diagnostic uncertainty or if symptoms are not following an expected pattern, then a considered referral for imaging is absolutely the right step.
When Imaging Is the Right Choice
Being conservative about routine scanning is not the same as avoiding diagnostics when they matter. At Sundial, the goal is always the right investigation for the right person at the right time and there are circumstances where imaging becomes genuinely important.
Imaging is warranted when:
- A serious underlying cause is suspected (fracture, infection, cancer, inflammatory condition such as ankylosing spondylitis)
- Symptoms are worsening unexpectedly or not following the anticipated pattern
- There are progressive neurological deficits (worsening weakness, significant change in sensation or any change in bladder or bowel function: the latter requires same-day emergency assessment)
- Surgery or an interventional procedure is being seriously considered
- Diagnostic uncertainty remains after an appropriate period of assessment and treatment
In any of these situations, a referral for imaging or for specialist medical opinion is the correct and responsible action. An evidence-based clinic does not avoid scans; it uses them purposefully. And when a referral is needed, our clinicians will ensure this is communicated clearly and handled as quickly as possible.
Why This Is Particularly Relevant for People in Sussex Right Now
For people across Brighton, Hove and the surrounding areas, the current state of NHS diagnostic services creates a real practical challenge. Waiting weeks or months for imaging while living with pain that prevents you from walking, working, sleeping or doing the things you enjoy is genuinely difficult.
What the evidence shows is that in the majority of cases, you do not have to wait for a scan to start getting better. Most common MSK conditions, including mechanical low back pain, neck pain, sciatica, shoulder problems, hip and knee pain, can be assessed thoroughly in an initial consultation and meaningful treatment can begin straight away.
This is not a compromise position while you wait for imaging. For most people, it is simply the best-evidenced approach to getting you moving and functioning as well as possible, as quickly as possible.
What Good Self-Management Looks Like While You Wait
Whatever stage you are at, there are things that help and things that are likely to make matters worse. Here is a brief and practical guide.
Things that generally help:
- Keep moving. Bed rest and prolonged inactivity are consistently associated with worse outcomes from back and MSK pain. You do not need to push through severe pain, but gentle, regular movement (even short walks) is usually beneficial.
- Return to your normal activities as far as you comfortably can. Whether that is gardening, a gentle swim, a round of golf or a walk along the seafront, keeping activity in your life matters.
- Understand that pain does not always mean harm. Sensitised nervous systems can generate significant pain even when no new tissue damage is occurring. This is not “in your head”: it is well-established pain science and understanding it can make a real difference to recovery.
- Sleep matters more than most people realise. Poor sleep has a direct effect on pain sensitivity. If pain is disrupting your sleep, mention this to your clinician. There are things that can help.
Things that tend to make matters worse:
- Searching online for the worst possible explanation for your symptoms
- Avoiding all movement out of fear of making things worse
- Waiting passively for a scan before doing anything
- Assuming a disc bulge or degeneration on a scan means permanent damage (it very often does not)
Red flags to act on promptly: if you develop loss of control of your bladder or bowel, significant weakness in a leg, numbness in the groin or inner thigh, or fever alongside back pain, do not wait for a clinic appointment: go directly to your nearest emergency department or call 999.
How a Sundial Assessment Can Help You
At Sundial Clinics in Brighton, physiotherapists and chiropractors work alongside each other and with our sports massage therapists to offer the kind of multidisciplinary assessment that national guidance recommends.
Our approach at an initial consultation is to get a clear picture of what is going on for you specifically, not just which structure might be involved, but what your life looks like, what matters to you and what a good outcome actually means in your situation. From that starting point, we can:
- Tell you whether anything requires urgent referral or further investigation
- Explain what we believe is driving your symptoms, in plain language
- Outline what evidence-based treatment is most likely to help
- Give you a realistic sense of what recovery looks like and how long it might take
- Start hands-on care, exercise guidance or rehabilitation at that same appointment if appropriate
- Refer for imaging or specialist opinion if this is genuinely needed
We do not use scans routinely and we do not use them to justify treatment that the evidence would support without them. What we do is assess carefully, explain clearly, treat where we can and refer where we should.
If you are in Brighton, Hove, Kemptown, Rottingdean, Saltdean, Lewes, Shoreham, Peacehaven or Worthing and you are sitting on a waiting list for an MRI while your pain is affecting your daily life, it may be worth knowing that there is usually a sensible step you can take right now before that scan happens.
A Realistic Sense of Timescales
One of the most useful things a clinician can offer is a conversation about recovery. This varies considerably depending on the nature of the problem, its duration, and individual factors but as a general guide:
- Acute mechanical back pain (a sudden onset, perhaps after a lift or twist). Many people notice significant improvement within 2–6 weeks with appropriate management.
- Persistent or recurring back pain. Progress is often more gradual, with meaningful improvement typically occurring over 6–12 weeks of active rehabilitation. Many people are not back to full function within this time, but most are substantially better.
- Nerve-related symptoms (sciatica). These can take longer, sometimes 3–6 months for full resolution but the trajectory matters more than the timeline. If things are moving in the right direction, that is meaningful progress.
These are general patterns, not guarantees. Your clinician will be able to give you a more personal and accurate picture.
Frequently Asked Questions
Do I need an MRI before I can be seen at Sundial Clinics? No. You can book a consultation without any prior imaging. Our clinicians will assess you thoroughly and determine whether imaging is needed during or after the initial appointment.
Can a physiotherapist or chiropractor refer me for an MRI? Physiotherapists and chiropractors in private practice can recommend imaging and write referral letters, which can be actioned through your GP or via private radiology services. If there is a clinical reason for imaging, we will advise you clearly.
What if my scan shows a disc bulge or degeneration? These findings are extremely common in adults of all ages, including people with no pain at all. Our clinicians are experienced in interpreting imaging in context alongside your symptoms, history and examination findings and will explain clearly what is and is not likely to be relevant to your situation.
What if I am already on an NHS waiting list for a scan? You can still come for an assessment. In many cases, we can help you start recovering while you wait. In some cases, we may be able to help clarify whether the scan is still necessary or support you in navigating the referral process.
Is physiotherapy or chiropractic right for every MSK problem? Not always, and we will always tell you if another type of care is more appropriate. Some conditions require medical management, specialist orthopaedic or neurological assessment or other investigations. Our role includes identifying these situations and making sure you get to the right place.
What is the difference between seeing a physiotherapist and a chiropractor at Sundial? Both professions are trained to assess and treat MSK conditions and share a commitment to evidence-based practice. There is considerable overlap in what they do. At Sundial, we work as a multidisciplinary team, and your clinician will be well-placed to advise you on who is the most appropriate fit for your particular problem.
How quickly can I be seen at Sundial Clinics? We aim to offer appointments promptly. You can find current availability and book online or call us directly to discuss your situation.
About Matthew Bennett, Chiropractor Brighton
Matthew Bennett is the founder and principal chiropractor at Sundial Clinics Brighton, established in 1991. With over 35 years of clinical experience, Matthew qualified from the Anglo-European College of Chiropractic in 1987 and served as President of the British Chiropractic Association for four years. As a Fellow of the Royal College of Chiropractors and former team chiropractor for Brighton and Hove Albion FC and the British Alpine Ski Team, Matthew combines evidence-based chiropractic treatment with sports performance expertise. His authority in musculoskeletal health has been recognised through national media appearances, expert witness roles and contributions to professional publications. Matthew’s commitment to clinical excellence ensures patients receive the most effective chiropractic care in Brighton.
References
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811–816.
Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36(12):2394–2399.
National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE Guideline NG59. Published 2016, updated 2020.
Academy of Medical Royal Colleges. Evidence-Based Interventions: Low back pain imaging.
Royal College of Radiologists. Nearly half of NHS trusts missing test waiting time target as backlogs grow. Published 2025.
Otto-Ketterer et al. (2022) Biopsychosocial factors for chronicity in individuals with non-specific low back pain: an umbrella review. Int J Environ Res Public Health. 2022;19(16):10286.
NHS England. An improvement framework to reduce community musculoskeletal waits while delivering best outcomes and experience.