Why Your MRI Doesn't Always Explain Your Pain
One of the most common conversations I have with patients goes something like this:
"My MRI showed a bulging disc."
"My MRI showed arthritis."
"My MRI showed a torn labrum."
"My MRI showed a rotator cuff tear."
Then they look at me and ask:
"So that's why I hurt, right?"
Maybe.
Maybe not.
This is one of the most important concepts for patients to understand when it comes to pain and injuries.
Just because something shows up on an MRI does not automatically mean it's the source of your pain.
In fact, research has repeatedly shown that many people walking around completely pain-free have MRI findings that sound downright terrifying.
The reality is that imaging is a tool. A very useful tool. But it's only one piece of the puzzle.
What an MRI does well
Let's start with the good news.
MRI technology is incredible.
It allows us to see structures inside the body with remarkable detail.
We can evaluate:
Discs
Tendons
Ligaments
Muscles
Cartilage
Menisci
Labrum
Nerves
When used appropriately, MRI can provide valuable information and help guide treatment decisions.
I order and review imaging regularly as part of patient care.
The problem isn't the MRI itself.
The problem is how people interpret the results.
The surprising truth about MRI findings
One of the most famous studies in musculoskeletal medicine was published in The New England Journal of Medicine.
Researchers performed MRI scans on people with absolutely no low back pain.
The results were shocking.
Many of these healthy, pain-free individuals had:
Disc bulges
Disc protrusions
Degenerative changes
Yet they had no symptoms whatsoever.
Since then, similar findings have been demonstrated in the:
Neck
Shoulder
Hip
Knee
Research published in The American Journal of Sports Medicine has shown that many asymptomatic adults have labral tears in their hips and shoulders.
Studies have also found rotator cuff tears in people who have no shoulder pain at all.
Read that again.
People can have tears and abnormalities on MRI and feel perfectly fine.
So why does this happen?
Because imaging shows structure.
Pain is more complicated than structure.
Pain is influenced by:
Tissue health
Movement patterns
Strength
Mobility
Nervous system sensitivity
Stress
Sleep
Activity levels
That's why two people can have nearly identical MRI findings and completely different symptoms.
One person hurts.
The other doesn't.
The MRI alone doesn't explain the difference.
The "gray hair" analogy
One of my favorite ways to explain this is using gray hair.
As we age, many of us develop gray hair.
It's normal.
It's expected.
It doesn't necessarily mean something is wrong.
Many MRI findings are similar.
Disc degeneration.
Mild arthritis.
Meniscal wear.
Labral fraying.
These changes are often a normal part of aging.
The presence of those findings does not automatically mean they're causing your symptoms.
When imaging is helpful
Now let's be clear.
I'm not saying MRIs are useless.
Far from it.
Imaging can be extremely valuable when:
Symptoms are severe
Significant trauma occurred
Surgery is being considered
Serious pathology is suspected
Conservative treatment isn't progressing as expected
The key is matching the MRI findings to the patient's history, symptoms, and physical examination.
That's where clinical reasoning matters.
How I approach imaging in the clinic
At Modern Movement Physical Therapy in Scottsdale, I always tell patients the same thing:
Treat the patient, not the MRI.
If someone has a rotator cuff tear on imaging but demonstrates excellent strength, good mobility, and symptoms that don't match the MRI findings, we need to take that into account.
Likewise, if someone has a completely normal MRI but is experiencing significant pain, that doesn't mean their symptoms aren't real.
The physical examination is often just as important as the imaging itself.
Sometimes more important.
The surgery conversation
One of the biggest mistakes I see is patients assuming an abnormal MRI automatically means surgery.
Fortunately, that's often not the case.
Research has shown that many conditions can improve significantly with conservative treatment.
This includes:
Rotator cuff tears
Meniscus injuries
Low back pain
Degenerative disc disease
Hip impingement
Tendinopathies
That doesn't mean surgery is never appropriate.
It simply means an MRI finding alone rarely dictates the best treatment.
The entire clinical picture matters.
The bottom line
MRIs are incredibly valuable tools, but they don't always tell the whole story.
Many imaging findings that sound alarming are commonly seen in people with no pain at all.
That's why treatment decisions should never be based solely on imaging results.
At Modern Movement Physical Therapy in Scottsdale, I combine a thorough examination, movement assessment, strength testing, and imaging review to understand the complete picture.
Because your MRI is part of your story.
It's just not the entire story.
Take good care of your body, it's the only one you have.
Yours in health,
Dr. Michael Price