You Are Not Your Image: Understanding MRI Findings in Pain Management
As a physical therapist, I often encounter patients who feel defined by their MRI results. Many believe that an abnormal finding on an MRI directly correlates with their pain, leading to unnecessary anxiety and invasive treatments. However, research consistently shows that imaging findings do not always correlate with clinical symptoms.
For instance, studies indicate that around 30% of asymptomatic individuals have partial thickness rotator cuff tears (Kukorelli et al., 2015). Similarly, a significant percentage—nearly 80%—of people over 40 exhibit disc bulges without any accompanying pain (Jensen et al., 1994). These statistics illustrate a critical point: just because an MRI shows an issue does not mean it is the source of pain or dysfunction.
In my practice, I emphasize the importance of clinical presentation over imaging findings. MRIs can often lead to false positives, resulting in unnecessary worry and interventions that may not address the root cause of the issue. For most patients, conservative treatment strategies—like physical therapy—are not only sufficient but also preferable. I typically do not recommend MRI imaging before initiating physical therapy, as many conditions can be effectively managed with targeted exercises and manual techniques. Expensive imaging, injections, and surgeries are rarely warranted, except in cases where red flags are present, such as severe neurological deficits or significant trauma.
By focusing on function and movement rather than images, we can develop a personalized treatment plan that addresses your unique needs. Remember, your pain does not define you, and often the best course of action begins with a comprehensive clinical assessment rather than an MRI.
References:
Kukorelli T, et al. Partial Thickness Rotator Cuff Tears: A Study of Asymptomatic Subjects. Orthopaedic Journal of Sports Medicine. 2015;3(2):2325967115585693.
Jensen MC, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. New England Journal of Medicine. 1994;331(2):69-73.
