Do I need an MRI?

When you go to the doctor’s office complaining of pain, it is not uncommon for them to write you a script for an X-ray, MRI, or other medical imaging. When it comes to ordering an image, one of the most important questions a medical provider should ask is, “ Will information from an image change the plan of care or result in improved outcomes for the patient?”  Many times the answer is no.

X-rays, MRIs and other medical imaging should be ordered when red flags are present.  Red flags are indications that a more serious medical condition exists and requires further medical work up and treatment. As the patient, it is important to know that your physicians and physical therapists are trained in school to monitor for these red flags and refer out for further work up when need. Typically, imaging is ordered without the presence of red flags in the hopes of better understanding where your pain is coming from. Many times though, the X-ray, MRI, or other medical imaging is either unremarkable or may show some natural aging changes in the body like arthritis and degenerative discs. It is important to note, that these findings are not always linked to the pain you are experiencing.

There have been countless studies examining the relationship between what is found on imaging and the pain people are experiencing. Here a few facts to keep in mind, the next time you have an image done:

  • Among 20-22 year old participants without a history of low back pain, 48% had at least one degenerative disc and 25% with a bulging disc.3
  • 85% of adults who do not report knee pain had knee osteoarthritis on their X-ray1
  • In individuals > 60 years old who had a shoulder MRI, 50% of them showed they had rotator cuff tears that the participants didn’t even know about2

Remember, as your body undergoes the natural aging process, many of the changes seen on a medical image are normal and do not mean you will have an increased likelihood in experiencing pain or having permanent pain. The pain you are experiencing may be caused by issues that cannot be picked up on imaging like:

  • Muscles imbalances occur when one muscle is stronger than its opposing muscle. When there is an imbalance it places you at increased risk for experiencing pain or an injury because the muscles aren’t working as well together.
  • Muscle weakness occurs when the muscles are not used or activated correctly. For example, low back pain may be caused by poor posture throughout the work day. Your poor posture may be due to decrease activation, strength and use of your core muscles.  By improving the activation, endurance and strength of your core muscles it can help alleviate back pain.
  • Altered movement patterns may place increased stress on joints leading to increased pain. If you are performing repetitive movements throughout the day, you may be altering the way you move without even noticing it. By altering your movement pattern, your body is not functioning as well as it could resulting in compensations that can place increased stress on certain body parts.
  • Increased tissue tension occurs when your muscles are over working. When your muscles are in this state, they become tense and result in increased tissue tension or knots. This increased tension prevents your muscles form working properly and can contribute to the pain you are experiencing.

Whether the pain you are experiencing is caused by what is seen on the image or not, physical therapist are here to help you manage and resolve your pain.   If you had imaging done with no real answers and are still having pain, call Total Performance physical therapy today to make an appointment with one of our physical therapists!


  1. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature.BMC Musculoskeletal Disorders. 2008;9:1-11. doi: 10.1186/1471-2474-9-116.
  2. Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders.J Bone Joint Surg Am. 1995;77(1):10-15.
  3. Takatalo J, Karppinen J, Niinimäki J, et al. Prevalence of degenerative imaging findings in lumbar magnetic resonance imaging among young adults.Spine. 2009;34(16):1716-1721. doi: 10.1097/BRS.0b013e3181ac5fec.

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