Your MRI Doesn't Tell the Whole Story
"My MRI says I have a disc bulge. Is that why I'm in pain?"
It's one of the most common questions we hear in the clinics.
The answer is:
Maybe, but not necessarily.
An MRI is an excellent tool. It shows us the structure of your body, your bones, discs, joints, ligaments, and other tissues. But it doesn't tell us how those tissues are functioning, how you're moving, or whether a particular finding is actually causing your symptoms.
Here's an example.
Imagine two people have the exact same MRI. Both have a small disc bulge.
One has severe back pain.
The other runs 10 kilometres every weekend and has no pain at all.
How is that possible?
Because pain is much more complex than a picture.
An MRI can't measure muscle strength, movement quality, balance, confidence, sleep, stress, or how sensitive your nervous system has become. All of these can influence how pain is experienced and how someone functions. An MRI is one piece of the puzzle—not the whole picture.
Research has also shown that many MRI findings, including disc bulges, degeneration, and arthritis, are common in people who have no pain whatsoever. These findings often become more common with age and may simply reflect normal changes rather than the source of someone's symptoms.
That doesn't mean MRI findings are unimportant.
Sometimes imaging identifies the source of a person's symptoms and plays a critical role in diagnosis and treatment. But the findings must always be interpreted alongside your history and physical examination. The same MRI finding can be very important for one person and completely incidental for another.
That's why, as physiotherapists, we don't treat MRI reports, we treat people.
We listen to your story, examine how your symptoms behave, assess how you move, and use imaging when it helps complete the picture.
The goal isn't to find the "perfect" MRI, it’s to understand the whole person. Your symptoms, your story, your physical examination, your goals, and your imaging all provide valuable information. When these pieces are considered together, we can make better decisions, provide more meaningful treatment, and help you return to the activities that matter most to you.
References:
Balza, R., et al. (2023). Symptom-imaging correlation in lumbar spine pain. Skeletal Radiology.
Brinjikji, W., Luetmer, P. H., Comstock, B., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816.
Brinjikji, W., Diehn, F. E., Jarvik, J. G., et al. (2015). MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: A systematic review and meta-analysis. American Journal of Neuroradiology, 36(12), 2394–2399.
Jarvik, J. G., & Deyo, R. A. (2002). Diagnostic evaluation of low back pain with emphasis on imaging. Annals of Internal Medicine, 137(7), 586–597.
