Why Your X-Ray May Not Explain Your Pain

Getting an MRI or X-ray for back or joint pain often feels like a necessary step toward understanding what's wrong. Sometimes it is essential. But the relationship between imaging findings and pain is much weaker than most patients expect, and a scan result can sometimes do more harm than good.

The prevalence of 'abnormal' findings in pain-free people

Studies imaging people with no pain consistently find high rates of findings that sound alarming on a report. In adults over 40:

• Disc bulges or protrusions: present in around 50-80% of asymptomatic people
• Disc degeneration: present in the majority of people over 50
• Rotator cuff tears: present in approximately 50% of people over 60 with no shoulder pain
• Knee cartilage changes: present in most people over 45

What this means for you

A finding on imaging is not automatically the cause of your pain. It may be a coincidental finding that has been present for years. This is why treating the scan rather than the patient is a problem - it leads to unnecessary procedures, unnecessary fear, and sometimes surgeries that don't resolve the pain because the structural finding wasn't actually the cause.

When imaging does matter

Imaging is important when red flags are present, when a serious injury (fracture, complete tendon rupture) is suspected, when symptoms aren't following the expected course, or when a decision about surgery needs to be made. For straightforward back pain or shoulder pain without neurological signs, early imaging rarely changes management.

A different way to think about it

Pain is an experience, not a structure. The brain generates pain in response to perceived threat, not only in response to structural damage. Treating the whole person - addressing load, movement quality, sleep, and psychological factors - produces better outcomes than chasing a scan finding.