Your MRI is not the Final Verdict
MRI Findings That Look Alarming are Often Completely Normal with Age
When a radiologist reads an MRI, they are describing everything they can see. Changes in tissue, variations in structure, signs of wear. What the report cannot tell you is whether any of those findings are actually responsible for your symptoms. That distinction matters enormously.
Research has consistently shown that many common MRI findings are present in people who have absolutely no pain at all. A large study published in the American Journal of Neuroradiology found that among people with no back pain, more than 50% of those over 40 had disc degeneration visible on MRI, and over 30% had disc bulges. By the age of 60, those numbers climb even higher. These are not sick people. These are ordinary adults whose spines look exactly the way a spine that has been used for 60 years tends to look.
The same pattern holds for the shoulder. Studies looking at rotator cuff tears in people with no shoulder symptoms have found that approximately 1 in 2 people over 60 have rotator cuff changes on imaging, many with no shoulder pain. The tendons change as we age. They thin, they develop small tears, and they show signs of what imaging reports often call "degeneration." But in many people, these changes produce no pain whatsoever.
"A scan tells you what a structure looks like. It cannot tell you why you are hurting, or whether that structure is the reason."
Why Do Some People with These Findings Have Pain While Others Don't?
This is the question that sits at the heart of modern pain science, and the honest answer is that pain is not a simple alarm system that fires when damage is detected. It is a protective response generated by the brain based on a huge range of inputs, many of which have nothing to do with structural findings on a scan.
Physical contributors
Muscle strength and balance play a major role. A person with a disc bulge who has strong, well-conditioned muscles supporting the spine may have no pain at all. The same disc bulge in someone with weakened core muscles, poor movement patterns, or a history of prolonged sitting may be a completely different experience. The finding is identical. The context is not.
Lifestyle and load
How much we move, how we move, and how long we've been sitting, lifting, or carrying in certain ways all affect whether a structural change becomes symptomatic. Physical deconditioning, losing strength and fitness over time, often amplifies pain signals even when the underlying structure hasn't changed.
The role of the nervous system
When pain persists for weeks or months, the nervous system can become sensitised, essentially turning up the volume on pain signals even when the original trigger is no longer active. This is known as central sensitisation, and it means that someone can be in significant pain even when their tissue is healing, or even when no tissue damage was ever present. It also explains why two people with identical MRI findings can have completely different pain experiences.
Psychological and social factors
Stress, anxiety, poor sleep, and fear of movement all influence how much pain a person experiences. This is not a suggestion that pain is "in your head." It is physiology. The brain processes threat signals from the body alongside everything else it knows about a person's situation, and when stress or fear is high, pain tends to amplify. Understanding this is not discouraging. It is actually empowering because it opens up more avenues for recovery.
What This Means for How We Approach Your pain
At Enriching Health, when someone comes to us with a scan report and a list of findings, we don't dismiss the imaging. We simply don't treat it as the whole story. Our role as Exercise Physiologists is to look at the person in front of us, their strength, their movement patterns, their history, and their goals, and build a programme that addresses what's actually driving their experience of pain.
This usually involves graded exercise. We start with movements that are safe and manageable and progressively build strength and confidence over time. It may also involve education because understanding that a finding on a scan does not mean your body is broken or fragile is genuinely therapeutic. Fear of movement is one of the biggest barriers to recovery, and it's largely driven by scan reports that haven't been explained well.
The evidence for this approach is strong. Exercise has been shown to reduce pain and improve function across a wide range of musculoskeletal conditions, independent of whether structural findings change on imaging. People get better not because their disc bulge resolves, but because their muscles get stronger, their movement improves, and their nervous system recalibrates.
When Imaging is Genuinely Useful
None of this means MRI is without value. Imaging is important when there are red flag symptoms such as significant neurological changes, unexplained weight loss, trauma, or symptoms that suggest something beyond a musculoskeletal cause. In these cases, ruling out serious pathology is exactly what imaging is for. Your GP and specialists are best placed to advise on whether a scan is clinically indicated in your situation.
The concern isn't with imaging itself. It's with the tendency to treat every finding as a diagnosis and every structural variation as a problem requiring intervention. In many cases, the finding was there years before the pain began. In many more, it will still be there after the pain has resolved.
Living in Panania, Padstow, East Hills or nearby? Let's talk about your scan.
If you've received an MRI report and aren't sure what it means for your movement or your pain, our Exercise Physiologists in Panania can help you make sense of it and build a plan that focuses on getting you back to what you love doing. We work with clients across Milperra, Revesby, Picnic Point, Bankstown and the surrounding areas.
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