WHAT YOUR MRI DOESN’T TELL YOU ABOUT PAIN
What Your MRI Doesn’t Tell You About Pain
What Your MRI Doesn’t Tell You About Pain
Have you ever had an MRI or X-ray that showed a disc bulge, degeneration, arthritis, a tendon tear, or another finding that sounded concerning?
It’s easy to read those words on an imaging report and assume they must be the reason you’re in pain. But imaging doesn’t always tell the whole story.
Imaging Findings Are More Common Than You Think
One of the most important things to understand about imaging is that many findings we see on MRIs are also present in people who have no pain at all.
A large systematic review by Brinjikji and colleagues looked at spinal imaging from 3,110 people without back pain. They found that signs of disc degeneration were already present in 37% of 20-year-olds, increasing to 96% of 80-year-olds. Disc bulges were found in 30% of pain-free 20-year-olds and 84% of pain-free 80-year-olds.
In other words, changes on imaging become increasingly common as we get older — even when they aren’t causing symptoms.
A helpful way to think about this is like wrinkles on the inside. We expect our skin and hair to change with age, and our joints, discs, and tendons change too. The presence of those changes doesn’t automatically mean something is damaged or that it is the source of your pain.
And this isn’t only true for the spine.
A 2026 study published in JAMA Internal Medicine looked at shoulder MRIs in 602 adults between the ages of 41 and 76. Almost 99% had at least one rotator cuff abnormality on MRI. These findings were present in 96% of shoulders without symptoms and 98% of shoulders with symptoms.
Similar findings have been seen at the knee. A systematic review of 63 studies found cartilage changes on MRI in 43% of asymptomatic adults over 40, despite these individuals having no knee pain or previous knee injury.
This doesn’t mean imaging findings never matter. It means they need to be interpreted in context.
Pain Is More Complex Than a Picture
An MRI gives us a detailed picture of the structures in your body, but it can’t tell us everything.
It can’t show us:
How well you move
How strong you are
What activities aggravate or improve your symptoms
How much load your body can currently tolerate
How your symptoms change throughout the day
How sleep, stress, activity and recovery may be influencing your pain
This is why two people can have very similar MRI findings but completely different symptoms.
One person may have a disc bulge and significant back pain, while another person with a very similar-looking disc may have no pain at all.
The scan is one piece of the puzzle — not the entire picture.
So, Do MRIs Matter?
Absolutely.
Imaging can be extremely valuable when there is concern about a significant injury or medical condition, when symptoms aren’t progressing as expected, or when the results would change how your condition is managed.
The important part is interpreting those findings alongside your symptoms and a thorough clinical assessment.
As physiotherapists, we don’t just look at what your MRI says. We look at you — your symptoms, movement, strength, function, goals, and how your body responds during an assessment.
You Are Not Your MRI
Seeing words like “degeneration,” “tear,” “arthritis,” or “disc bulge” on an imaging report can understandably make you nervous about movement.
It may even make you feel like you need to protect that area or avoid certain activities because something is “damaged.”
But an imaging finding doesn’t automatically mean your body is fragile or that movement is unsafe.
Research consistently shows that structural findings can exist in people who feel completely well. What matters is whether the imaging findings actually fit with your symptoms, history and physical assessment.
For many musculoskeletal conditions, gradually returning to movement, rebuilding strength, and improving your tolerance to activity are important parts of recovery — even when imaging findings are present.
Your MRI can provide useful information.
It just doesn’t tell your whole story.
If you’re dealing with pain and aren’t sure what your imaging results mean for you, a physiotherapy assessment can help put those findings into context and create a plan based on your symptoms, function, and goals.
References
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR American Journal of Neuroradiology. 2015;36(4):811–816.
Ibounig T, Järvinen TLN, Raatikainen S, et al. Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA Internal Medicine. 2026;186(4):406–414.
Culvenor AG, Øiestad BE, Hart HF, et al. Prevalence of Knee Osteoarthritis Features on Magnetic Resonance Imaging in Asymptomatic Uninjured Adults: A Systematic Review and Meta-analysis. British Journal of Sports Medicine. 2019;53(20):1268–1278.
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