An MRI will tell me exactly what's causing my pain
A patient came to my clinic holding her MRI report, underlined in red. She was certain the 'mild disc bulge at L4/5' explained all her pain. She had no leg symptoms, walked normally, and her examination was unremarkable. That finding was incidental. Three months of physiotherapy later, she was hiking again.
What Patients SayI finally got an MRI. Now I'll know exactly what's causing my pain and what needs to be fixed.
Where Did This Come From?
MRI is miraculous technology. It gives us detailed images of soft tissue — discs, nerves, the spinal cord — that we simply couldn't see before. It's natural to assume that better images equal better answers. If only it were that simple.
The problem isn't the technology. The problem is the assumption that visible structural changes on an image directly correspond to the person's pain. That assumption, it turns out, is frequently wrong. Radiologists report what they see. They're not in the room with you. They can't tell you whether a finding they're describing is the cause of your symptoms, a coincidental finding, or a normal variant for someone your age.
We've also created a culture of "scan anxiety" — patients feel they don't have answers until they've had imaging. And then once they have imaging, every finding on that report feels like an explanation and a threat. "Mild disc bulge at L4/5" becomes the villain in your pain story, whether it actually is or not.
What the Science Actually Says
A famous study published in the New England Journal of Medicine scanned the spines of 98 completely asymptomatic people — no back pain at all. The findings were startling: 52% had disc bulges at at least one level. 27% had disc protrusions. 38% had degenerative changes. These people had no pain. At all. The "abnormalities" on their scans were just... what their spines looked like.
This finding has been replicated many times since. The prevalence of asymptomatic disc herniations, degenerative disease, and stenosis on MRI in pain-free populations is substantial and increases with age. By age 60, the majority of asymptomatic adults will have at least one "significant" finding on a spine MRI. What does this mean for you? It means that finding something on an MRI doesn't automatically mean it's the cause of your pain. A careful clinician correlates your symptoms, your physical examination, and your imaging findings.
All three matter. The image alone is just a picture.
The Verdict
An MRI doesn't tell you "exactly" anything. It shows structural anatomy. Interpreting what those findings mean for your specific pain requires clinical judgment — not just image reading.
What To Do Instead
- Have your imaging reviewed by a clinician who also examines you — the correlation between exam findings and imaging is what matters
- Ask your doctor: "Does this finding correlate with my symptoms?" Not just "what does this finding mean?"
- Don't catastrophise incidental findings — "mild disc bulge" at your age may be completely normal and clinically irrelevant
- Remember: many successful treatment approaches for back pain don't target specific imaging findings at all
Yellow Flags — Worth Monitoring
- A scan report that mentions a large herniation or significant nerve compression — this should be correlated with your symptoms; if you have significant neurological symptoms it may be relevant
- Multiple findings on a scan — it can be genuinely difficult to know which one (if any) is relevant; a specialist opinion helps
Red Flags — Get Checked Immediately
- Imaging showing cauda equina compression — especially if accompanied by relevant symptoms (bowel/bladder changes, saddle numbness)
- Imaging showing cord compression with myelopathy signs — this needs urgent specialist input
- A report describing a lesion that wasn't expected (possible tumour, infection, fracture) — urgent follow-up needed
- Boden SD et al., "Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects," Journal of Bone and Joint Surgery, 1990. Jensen MC et al., "MRI of the lumbar spine in people without back pain," NEJM, 1994.