Are Abnormal Imaging Findings Always Abnormal?

MRI or X-Ray reports are often full of words like degeneration, bulging disc, arthritis,

tear, or disc protrusion. It’s easy to read those findings and think, “There’s the

problem. That’s why I’m hurting.”

Imaging can sometimes tell us a lot about what is happening in the body, but it does not always tell us why someone is experiencing pain and it does not always identify which findings are clinically relevant.

Research has shown that many findings commonly described as “abnormal” are also present in people who have no pain or symptoms at all.

For example, MRI scans can show disc bulges, tears, and other changes in people who

don’t have back pain. So, while an MRI can show us what your tissues look like, it

doesn’t always tell us what is causing your pain.

Degenerative Changes are Common with Age:

This is particularly important when discussing the spine. A 2014 study, by Brinjikji and

colleagues, found that degenerative changes in the spine become increasingly common

with age, even in people without symptoms.

Percentage of asymptomatic individuals with disc degeneration by age:

80-89	70-79	60-69	50-59	40-49	30-39
96%	93%	88%	80%	50%	40%

This means that some degenerative findings on an MRI may reflect normal age-related

changes rather than being a direct cause of pain.

Pain Is More Than What Shows Up on a Scan

Pain is complex. Changes in our tissue can certainly play a role, but they are only one

piece of the puzzle. Strength, movement, activity level, recent changes in activity, sleep,

stress, and nervous-system sensitivity can all influence how someone experiences pain.

This is why two people can have similar imaging findings but very different symptoms.

Do Your MRI Results Mean You Need Surgery?

An imaging finding does not automatically mean that surgery is needed, and treatment

decisions should not be based on imaging alone. Depending on the specific condition

and symptoms, many musculoskeletal problems can improve with conservative treatment, including physical therapy. Your symptoms, physical examination, functional

limitations, goals, and response to treatment all matter.

Imaging can be an important tool, but it is just one piece of the puzzle. An MRI finding

does not automatically mean that it is the source of your pain, and it does not

automatically mean that you need surgery.

A physical therapist will consider imaging when it is relevant, but will also look at your

strength, movement, symptoms, function, and goals to determine what may be contributing to your pain and how to help you move forward.

The goal isn't to ignore your imaging results. It's to put it into context.

Resources:

1. 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. doi:10.3174/ajnr.A4173

2. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on

imaging. Ann Intern Med. 2002;137(7):586-597. doi:10.7326/0003-4819-137-7-

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