Why Imaging Doesn’t Always Tell the Whole Story

Written by Dr. Darin Fodor

It’s a scenario many people experience: you’re in pain, you get an X-ray or MRI, and the results either show something unexpected or show nothing at all. Understandably, this can be confusing. How can a scan look “normal” when you’re clearly in pain? Even more confusing, why might your report describe degeneration or a tear, even though you feel fine?

Let’s unpack why imaging doesn’t always correlate with symptoms and why that’s not necessarily a bad thing.

1. Imaging Shows Structure, Not Pain

Medical imaging like MRI, CT, or X-ray gives us a static picture of your anatomy, but pain is more than just what we see on a scan. Pain is influenced by a wide range of factors including inflammation, stress, sleep, past experiences, and how sensitive your nervous system is at a given time.

For example, two people can have the same disc bulge seen on an MRI, one person might have no symptoms at all, while the other might be in significant pain. Why? The scan only shows us the structure, not how your body is responding to it.

2. Age-Related Changes Are Often Normal

Imaging findings like disc degeneration, facet joint arthritis, or meniscal tears become more common as we age. In fact, studies have shown that:

• About 50% of people in their 40s have disc bulges on MRI or CT, however 50% of these people don’t have low back pain.

• Many individuals over 50 have rotator cuff tears without any shoulder pain.

• Knee meniscal tears are frequently found in people with no knee symptoms.

These findings are often part of the natural aging process, much like getting wrinkles or grey hair. Seeing them on a scan doesn’t automatically mean they’re the cause of your pain.

3. Scans Can’t Measure Function

A scan can’t tell us how strong your muscles are, how well you move, or how your body adapts during activity. Someone might have signs of joint degeneration on imaging, yet still be able to run marathons, lift weights, or play sports pain-free. On the other hand, someone with no visible changes on imaging might have significant movement dysfunction or be limited in daily activities.

That’s why a thorough physical assessment is so important, it gives us the context that imaging alone can’t provide.

4. Imaging Can Sometimes Create Fear

While imaging can be incredibly helpful when used appropriately, it can also lead to unnecessary worry if findings are interpreted without proper context. Technical terms like "degeneration" or "tear" may sound alarming, but they don’t always mean damage or danger. When patients are told they have a “bad back” or “worn out joints,” it can create fear and avoidance of movement, which can make the pain worse.

Educating patients that imaging findings are often part of a bigger picture is an essential part of modern, evidence-based care.

5. When Is Imaging Useful?

Imaging has its place, especially when:

• There’s concern for a fracture, infection, or more serious underlying condition.

• Symptoms aren’t improving with conservative care.

• Surgery is being considered and detailed anatomical information is needed.

But in most musculoskeletal cases, especially where there’s no trauma or red flags, clinical examination and patient history are the most reliable tools for guiding treatment.

Bottom Line:
Imaging is a tool, but it’s not the whole toolbox. Pain and function are complex, and what we see on a scan doesn’t always predict how someone feels or performs. That’s why personalized care based on your individual story, movement, and goals will always be more powerful than a picture alone.