Picture this: you’ve been dealing with a shoulder/hip/knee/back/insert any other body part issue, and your physician recommended an MRI. The results showed some “abnormalities”, potentially some arthritis or a slight tear in something. GASP! Your doctor said surgery isn’t necessary, and it can be managed conservatively. But since you have this abnormality on your MRI, you’ll never feel like you used too right?

The thing is, MRI findings can look and sound alarming, but when it comes to common orthopedic pains, they often don’t tell us what actually needs to be treated. Research consistently shows us that many “abnormalities” on MRI are also present in people with zero pain or dysfunction.

For example, a research paper titled Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain found that 52% of people without back pain had a bulging disc. Similarly, we see the same things in the knee and shoulder. Another article titled Asymptomatic Rotator Cuff Tears showed ~30–40% prevalence of NON-PAINFUL tears in middle-aged adults, and ~40–50% or greater in people over 60. Again, these people don’t have any pain or disability, but they had a rotator cuff tear on their MRI. These findings highlight a key point that many in the health profession are coming to understand; structural changes such as degeneration and tears seen on imaging are often normal, and not a direct cause of pain.

When surgery is not indicated (which is most of the time), MRI results rarely change the course of treatment in physical therapy. Why is that you ask? Time has shown that patient results are driven by how someone moves, loads their tissue, and builds strength rather than by what shows up on a scan.

The real driver of a full recovery is not the words on the page, it’s the plan behind the person. Pain is multifactorial, and we definitely can’t pin it on anatomy alone. What’s most important is the load and movement tolerance of that, as well as strength and stability, and even stress and sleep. If surgery isn’t the answer for you, then chasing a diagnosis on paper becomes a distraction from what actually works: progressive loading, movement retraining, and building capacity of the area. Our end goal shouldn’t be to fix what we see on an image, but to restore your body's function and confidence in movement.