Treating the Patient Not the Picture

“I have my x-ray and MRI results; do you want to see them”? This is a common question therapists receive during a patient’s first visit at their initial evaluation. Many patients are fearful of the results in an MRI report, such as; tear, herniation, degenerative disc disease, bulging, effusion, and edema, to name a few.  Should this make patients nervous? Does this tell the whole story?

What role does an MRI or X-ray play in a patient’s symptoms and treatment?

Imaging results are a slice of the pie in the grand picture of what a patient is feeling. It is a snapshot in time of what is going on in a very specific region, in a static position, but it does not tell the entire story. Bodies were made to bend, twist, move, and reach, and the coordination of our nervous and musculoskeletal system changes with every movement. Our bodies are extremely complex and all the body systems are integrated within each other, making someone’s pain more intricate than the results of an imaging test. A skilled therapist will be able to examine all the components affecting someone’s symptoms and put together a complete plan of care to address a patient’s pain and limitations.

Imaging of the Spine

Common results from imaging of the lumbar spine include degenerative disc disease, arthritis, and bulging discs. Most of these findings are likely already present in someone’s back before their pain began. A study in 2015 found that 52% of thirty-year-olds without low back pain have lumbar disc degeneration in their imaging results, and 80% of fifty-year-olds without low back pain have lumbar disc denegeration1. The conclusion: “These findings suggest that many imaging-based degenerative features may be part of normal aging and unassociated with low back pain”.  The findings of degenerative imaging results have likely been there for years when a person doesn’t have any pain. This begs the question, what is the cause of someone’s pain then?  To find that, we need to zoom out from that specific location of the imagining and take a look at the big picture, how the multiple body systems are interacting.

Imaging of the Shoulder

This same approach is also recommended for other parts of the body. A recent study showed that two out of every three patients over the age of 70 have rotator cuff tears and do not have any symptoms. (2) A similar study found that 40% of people with rotator cuff tears experience no symptoms. (3)

*I think we need to tie this back to imaging though. Just because you don’t have symptoms, doesn’t mean there isn’t damage to the joint. Just because there is damage to the joint, doesn’t mean you have to repair it. Something more eloquent than that, but I think we need to have a statement to wrap this up.

Imaging of the Knee

One study showed that there was only a 50% correlation between knee pain and arthritis. (4) Another found that 35% of college basketball players with NO KNEE PAIN showed significant abnormalities on MRI. (5)

Again, I think the findings are great, but what does this mean to the average person? If they have knee pain, or they have abnormalities, what is the directive? What should that patient do?

What to Look for in a Physical Therapist?

When the time is taken to examine all the components of our musculoskeletal and nervous system, good results are likely to follow. An in-depth, 60-minute, one-on-one evaluation will allow your skilled therapist to take a look at the big picture and examine how multiple body parts are functioning and affecting a patient’s pain. Excel Physical Therapists are able to spend ample time with patients to uncover the foundational issues, and make adjustments as symptoms change and improve. When you take a step back and see the whole picture, you can find the best solution and relief from your pain. Contact your local physical therapist to learn more and always discuss an MRI or any test results with your physician.

Scott Hoffman, PT, DPT – Jenkintown



Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173

Milgrom, Schaffler etal.1995

Reilly, Macleod etal.2006

Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC musculoskeletal disorders. 2008;9:116-116.

Horga, L.M., Hirschmann, A.C., Henckel, J. et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol 49, 1099–1107 (2020).


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