When your back hurts, it’s natural to want answers and want them fast. Many people think the fastest way to get those answers is through an MRI or X-ray. But here’s the truth: imaging can sometimes create more confusion than clarity.
Imaging Pitfalls: Why More Information Isn’t Always Better
MRIs and X-Rays are incredible tools, but they have their limits.
- They show structure, not function
- They show changes, not pain
- They pick up every little detail and imperfection, even things that have been there for years and have yet to cause a single symptom
- Images are a snapshot in time, they can not tell you how you feel while moving during your day-to-day activities
That means you can walk into an MRI with a backache…and walk about terrified because that MRI report mentioned terms like “degeneration,” “disc bulges,” and/or “arthritis.” These terms can sound alarming, but most of the time, they are normal age-related changes, not damage.
Imaging can absolutely be helpful in certain scenarios. Red flags like trauma, weakness in the legs, bowel or bladder changes, and unrelenting pain are all indicators that imaging would be appropriate. However, like we mentioned in the previous blog, low back pain for the vast majority of people is not medically serious or life threatening. This means for most people, imaging doesn’t lead to better results. In fact, it often increases anxiety, provokes unnecessary treatments, or promotes surgeries that weren’t needed.
The Brinjikji 2015 Study
A 2015 study reviewed over 3000 MRIs of people with no back pain at all. The purpose of this study was to get clarity on how common “abnormal findings” like degeneration, disc bulges, and arthritis really are.
Here’s what they found:
- 30% of 20-year-olds with no pain had disc bulges
- 40% of 30-year-olds with no pain had disc bulges
- 50% of 40 year olds with no pain had disc bulges
- 80% of 50-60 year olds with no pain had disc bulges
- Nearly everyone over 60 had some combination of arthritis, bulges, or degeneration with no back at all
Simply put: If you image the spine, you will likely find things whether your back hurts or not.
So when your MRI says “disc bulge,” it might just be describing your spine’s version of gray hair. It’s normal, expected, and not a problem by itself.
Why Scary Findings Rarely Equal Scary Problems
A radiology report can look intimidating, but here’s what most people don’t realize:
- A disc bulge doesn’t always mean there’s pressure on a nerve
- “Degeneration” is a normal part of aging, not a diagnosis
- The presence of arthritis on an image doesn’t dictate your pain levels or your future chances of experiencing low back pain
Like we mentioned in the previous blog, pain is influenced by many things:
- Movement Habits
- Stress Levels
- Sleep Quality
- Physical Conditioning
Imaging can’t capture any of those factors. This is why people can have “terrible” looking images with very little pain or normal looking images with severe pain.
The Real Question Patients Should Ask
Instead of asking: “What’s wrong with my MRI?”
Try asking: “What’s driving my pain? And what’s the plan to help me move better, get stronger, and return to my meaningful activities?”
A good clinician focuses on:
- How you move
- What positions help or hurt
- Which activities you want to get back to
- Your short and long term goals
- Mobillity, strength, and lifestyle factors
These are things that actually change long term outcomes, not the findings from an image of your spine.
Take the Next Step: Download our Low Back Pain Guide
If you’re tired of feeling confused
Frustrated with your pain
Scared to move after getting images of your spine
We put together a simple, evidence-based Low Back Pain Guide that explains:
- What actually drives most everyday low back pain
- Red flags you should watch for
- When imaging is truly necessary
- Self management strategies for your low back pain to try at home
- Ways to improve spinal mobility
- What to include in your exercise routine to improve low back stability, strength, and overall resiliency
Click here to download our FREE guide and start feeling better today
OR
Click here to schedule a FREE discovery visit to get your questions answered by someone who’s dedicated to finding the root causes of your low back pain
Dr. Cameron Whitehead
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