MRIs, x-rays, and other imaging technologies allow us to see the bones, muscles, cartilage, and other tissues that make up your back and spine. Scans and images can help doctors and researchers identify serious problems in the body that need attention.

But do the results of those images tell you why you have pain?

Imaging has a very important place in medicine. But research shows that there isn't always a direct link between imaging results and your symptoms. In other words, the results of your scans are often not the reason for your pain. Let’s take a look at some of the latest statistics:

  • Out of 98 “pain-free” athletes under 26 years old, only 4% had MRI results that were considered “normal” by musculoskeletal radiologists. [1] So basically, 96% of athletes who took part in this study showed signs of disc herniation and degeneration on their MRI scans. But none of them reported any pain.

  • A large-scale systematic literature review of 3,110 people with no back pain found spine degeneration to be present in a high number of people. The older the participant, the more likely they were to have spine degeneration. The researchers concluded that degenerative features are a normal part of the aging process without any connection to pain. [2] 

  • The American College of Physicians outlined evidence in 2011 that routine imaging is not associated with clinically meaningful benefits. They agreed it can even lead to harm, and advised that more testing does not lead to better care. [3]

We know that everyone’s experience of pain is different because everyone carries different factors in their backpack.* We also know our lower backs are unique. Even so, you may still be wondering why you have pain if it’s not directly related to what imaging shows.

In previous articles we’ve talked about why persistent pain is complex and why there is no single solution for treating long-term pain. It takes time to address the various factors in your backpack, calm your nervous system, and retrain your body.*

Remember that there is always something you can do to improve your lower back health. Movement and knowledge will get you there. With patience, consistency, and courage, you will slowly get better. In future lessons we’ll teach you how to focus on the great things your back allows you to do and to feel safe moving more despite “abnormalities” on your scans.

* We added a video and additional content to the article “Rethink Your Pain,” which you read in a previous playlist. In case you missed it, be sure to take a look at “Rethink Your Pain” in the Library of your Hinge Health app for important background information and context.

Key Takeaways

  1. Results from imaging technologies like MRIs & x-rays don't always reflect symptoms.

  2. It is common for people without any pain or symptoms to have abnormal findings on their scans.

  3. Don't rely on scans alone. There is always something you can do to take control of your pain.

References:

  1. Jensen, M. C., Brant-Zawadzki, M.N., Obuchowski, N., Modic, M. T., Malkasian, D., & Ross, J.S. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine, 331(2), 69-73.

  2. Rajeswaran, G., Turner, M., Gissane, C., & Healy, J. C. (2014). MRI findings in the lumbar spines of asymptomatic elite junior tennis players. Skeletal Radiology, 43(7), 925–932.

  3. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.

  4. Chou, R., Qaseem, A., Owens, D. K., & Shekelle, P. (2011). Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Annals of internal medicine, 154(3), 181-189.

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