You've been in pain for weeks. You get an MRI. The report comes back listing disc bulges, disc degeneration, and a handful of other findings that sound alarming. Your GP tells you these findings could be causing your pain.
But here's what often doesn't get mentioned: the same findings are present in the majority of people your age who have no back pain at all.
The Study That Changed How Physios Think About Imaging
In 2015, Brinjikji and colleagues published a systematic literature review in the American Journal of Neuroradiology that has since been cited over 900 times. They examined imaging from 3,110 asymptomatic individuals — people with zero back pain — across 33 studies.
What they found was striking. Degenerative spinal changes are not a sign of injury or damage. They are features of a normal spine that has been used over decades. Here is what they found in people with no pain whatsoever:
| Age | Disc Degeneration | Disc Bulge | Disc Protrusion |
|---|---|---|---|
| 20s | 37% | 30% | 29% |
| 40s | 68% | 50% | 36% |
| 50s | 80% | 60% | 40% |
| 60s | 88% | 69% | 43% |
| 70s+ | 93% | 77% | 50% |
What Imaging Shows — and What It Doesn't
Imaging is a picture of structure. It shows the shape and integrity of tissues at a specific moment in time. It does not show why you're in pain.
Pain is a complex output generated by the brain in response to perceived threat. It's influenced by the state of your tissues, yes — but also by stress, sleep, beliefs about your injury, previous experiences, and the activity of your nervous system.
This is why two people can have identical MRI findings and one is in severe pain while the other has none. It also explains why some people with severe, life-limiting back pain have "clear" scans — and why some people with alarming-sounding MRI reports have no pain at all.
What This Means for Your Treatment
If your back pain has been attributed primarily to what's on your imaging — and standard treatment hasn't worked — this is worth reconsidering.
It does not mean your pain isn't real. Back pain is real, significant, and deserves proper treatment. What it means is that the imaging finding may not be the primary driver of your pain. And that changes what the most effective treatment looks like.
Evidence-based management of low back pain focuses on:
- Progressive movement and loading — not rest and avoidance
- Strength training and building physical capacity
- Pain education — understanding that pain does not equal damage
- Addressing contributing factors like sleep, stress, and activity levels
- Hands-on treatment where appropriate
The research is clear that for non-specific low back pain, active rehabilitation produces better outcomes than passive treatment or avoidance.
The Bottom Line
Your MRI is one piece of the puzzle — not the diagnosis itself. A skilled physiotherapist will interpret imaging in the context of your full presentation: how it started, what makes it worse, what you're trying to get back to, and what the physical assessment shows.
If you've been told your pain is because of your scan findings and you're not getting better — there's more to the story.
We Assess the Person, Not the Picture
At House of Rehab, your imaging is one piece of information — not the conclusion. Book an initial consultation and let's look at the full picture.
Book an ACC Initial ConsultationBrinjikji W, Luetmer PH, Comstock B, et al. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology, 36(4), 811–816.