Do I Need a Scan for My Knee Pain? Why MRI Isn’t Always the Answer.

As a physiotherapist, one of the most common questions I hear in clinic is:👉 “Should I get a scan to find out what’s wrong with my knee?”

It’s a fair question — especially when pain or unusual symptoms cause worry. But the truth is, most people don’t need an MRI or X-ray to diagnose their knee problem. In fact, the latest NICE guidelines (used by the NHS) are clear: osteoarthritis and many other common knee issues can often be diagnosed clinically — through a thorough history and physical examination — without the need for imaging.

When a Scan Isn’t Needed

Scans often don’t add anything useful in situations like:

• Knee pain with no trauma (no injury event to trigger it).

• “Noisy knees” — clicking, crunching, or grinding sounds are common and don’t always mean something is wrong.

• Osteoarthritis — NICE guidance states this can be diagnosed clinically based on symptoms (e.g. stiffness, reduced function, pain) rather than automatically sending patients for an X-ray.

• Full range of motion, no swelling, and no mechanical symptoms — if your knee moves freely, isn’t locking or giving way, and there’s no red-flag history, a scan is unlikely to change management.

💡 Example: A recent patient came in worried about a “clicky knee.” They had no pain, no swelling, and full function. In this case, a scan would not provide any additional answers — reassurance and education were the most important “treatment.”

When a Scan Might Be Needed

Scans do play an important role in certain situations, such as:

• Trauma: If there’s been a fall, twist, or impact with immediate swelling or inability to bear weight → further imaging may be needed.

• Ottawa Knee Rules positive: These rules help identify when an X-ray is appropriate after trauma (e.g. age >55, inability to weight bear, isolated bony tenderness).

• Mechanical symptoms: True locking (the knee physically won’t straighten), catching, or repeated giving way may point to a meniscus or ligament issue that could need MRI.

• Red flag symptoms: Severe night pain, unexplained swelling, systemic symptoms (e.g. fever, weight loss), or suspicion of fracture/infection — urgent imaging required.

Why Over-Reliance on Scans Can Be a Problem

• Incidental findings: Scans often show “abnormalities” that aren’t causing symptoms (for example, meniscus changes or mild arthritis that are completely normal for age). This can cause anxiety without changing treatment.

• Delay in care: Waiting for scans can delay starting rehab, even though exercise and physiotherapy are usually the most effective first-line treatment.

• Increased costs and unnecessary medicalisation: Imaging should be used thoughtfully, not routinely.

The Takeaway

👉 You don’t always need a scan to understand and treat knee pain.👉 A good clinical assessment by a physiotherapist or healthcare professional is often enough to provide a diagnosis and a treatment plan.👉 Scans are most useful when there’s trauma, mechanical symptoms, or red-flag features that suggest something more serious.

At BetterMe Physiotherapy Clinics, we focus on expert assessment, reassurance, and active treatment — getting you back to movement and confidence, not just chasing scan results.

If you’re worried about knee pain or unsure whether you need imaging, book an appointment today. We’ll help you find the right path forward.

📍 Rainham, Kent📞 07429 097014🌐 www.bettermephysiotherapy.net