“Abnormal” MRIs and X-Rays From Pain-Free People: More Common Than You Think

Results from medical imaging – Xrays and MRIs – are not always the final word on pain and your ability to be physically active. These tools are vital in assisting medical providers to take an internal look at what ails us, but their ability to produce definitive diagnoses for the cause of musculoskeletal pains has been grossly over-utilized.

For instance, you may have pain and not have any abnormal findings on imaging. Or you may have abnormal findings, but not be in pain.

Your physical structure and level of “wear and tear” on an image doesn’t always correlate to your level of pain. That’s because everyone is is different, and some level of “abnormality” and “degeneration” in and around joints are common findings in many people who are not in pain.

Pain can be the result of many factors. A comprehensive assessment of all the physiological and psychological variables that contribute to it have greater significance than imaging alone.

An examination that looks at many components — including mobility, strength, posture, stress, body composition, nutrition, and other special tests—to assess the possibility of bone, muscle, ligament, or nerve damage can be more reliable than what you see on a film.

While radiologists can identify various tears and “abnormalities” on imaging with pinpoint precision, do they accurately correlate to someone’s pain and limitations? A host of recent studies suggest otherwise:

  • A 2011 study examined imaging of 283 shoulders with full-thickness rotator cuff tears. It would seem that these individuals would have some pain and weakness, however 65.4% of those people did not have symptoms and had full shoulder strength.
  • A systematic review, or research paper that analyzes multiple studies, examined imaging findings from 3110 individuals without back pain. The review found that the prevalence of disc degeneration in the spine was 37% in 20 year olds and increased throughout the lifespan to 96% in 80 year olds. Disc bulges were also present in 30% of the 20 year olds and 84% of the 80 year olds. However, all subjects did not have back pain!
  • Meniscus tears, or tears in the cartilage that cushions the knee, are commonly diagnosed causes of knee pain on MRIs. A 2016 study that examined the severity of meniscus tears during surgery did not correlate to a patient’s pre-operative complaints of pain or functional limitations.
  • Partial menisectomies, or a surgery that removes part of a torn meniscus, are the most commonly performed orthopedic surgeries in the U.S. Success rates of this procedure are highly variable. A Finnish study examined 146 patients with meniscus tears. 70 of those patients underwent a menisectomy, while the other 76 had a sham surgery in which incisions were made in the knee but no surgery to the meniscus was performed. There was NO clinically significant difference in outcomes after the surgeries.

Have you overcome an injury when imaging suggested you couldn’t? Share below. We’d love to hear about it!

About the Arthor

Dr. Tom Van Ornum is the owner and founder of Resurgent Performance Physical Therapy in Gaithersburg, Maryland. He received his Doctor of Physical Therapy and Bachelor of Science in Health Studies degrees from Boston University. He has worked with athletes of all ages, including the NFL, MLB, NBA, UFC, performing arts, and military special forces, as well as nationally ranked runners, triathletes, and weightlifters.

Dr. Tom pulls from a variety of disciplines when treating pain/dysfunction and understands that “everything is connected.” The foundations of his practice integrate a recognition that pain, stress and performance are outputs of the brain and that the overall well-being of a person depends on an optimal interaction with his or her environment. He strives to eliminate pain and maximize vitality in everyone he works with. He has multiple articles published in national publications and regularly consults for numerous companies across the country on health, wellness, and injury prevention.