You hurt your back. Your doctor ordered an MRI. The report came back with words like herniated disc, disc bulge, foraminal narrowing, or moderate degenerative changes. The assumption is that one explains the other. Here’s the thing: that assumption is often wrong. I’m going to say that again because it’s so important: the assumption that the findings on the MRI explain WHY you’re in pain is often wrong.
And it matters a lot for how you approach treatment.
The research on asymptomatic disc findings
Multiple large-scale imaging studies have scanned the spines of people with no back pain at all. By age 40, the majority of pain-free adults have at least one disc bulge visible on MRI. By age 60, degeneration and narrowing are nearly universal. These are people with no symptoms. Which means disc findings on imaging are not inherently pathological. They’re often a normal part of how spines age.
What is means for you is: if you have a disc bulge, you too can get back to being pain-free (just like the people in all of those studies).
What MRI actually tells you
MRI shows structure. It shows what’s there anatomically. What it doesn’t show is whether that structure is the source of your pain. Two people can have identical herniated discs on imaging and completely different pain experiences. That tells you something important about the relationship between imaging and pain.
The nocebo effect
Radiology reports use standardized language that sounds alarming to patients who aren’t trained to interpret it. Research has shown that patients who receive scary-sounding MRI language often have worse outcomes than those whose findings aren’t communicated in frightening terms, even when the physical findings are identical. Understanding your MRI findings accurately, rather than through the lens of fear, is itself part of treatment.
What actually predicts recovery
Movement assessment predicts recovery better than imaging for the vast majority of back pain presentations. If a patient can find a direction of movement that significantly reduces their pain, that’s a better predictor of a good outcome than any imaging finding.
TLDR: don’t let an MRI convince you that you are damaged. Don’t let it discourage you. Even in the worst cases we’ve seem, there are improvements that can be made to improve quality of life and increase activity levels. It all depends on the specifics of what we find in our movement assessment and exam.
At Land and Sea PT in Oceanside, we start with movement, not imaging. Come in and let us assess what’s actually going on.
If you want to contact us or book an appointment, check our business profile page.
Dr. Jonny Blue is a Doctor of Physical Therapy and founder of Land and Sea Physical Therapy in Oceanside, CA. He specializes in orthopedic PT, root cause methodology, and helping active adults in North County San Diego get back to the activities they love without surgery or pain medication.