MRI/X-ray: A misguided image

X-ray / MRI Misguided Image

“I have a disc herniation.  There is no way you can help me.”

“My physician says that my back is shot, I think I’m going to have pain forever.”

“I have spinal stenosis, I can’t move that way.”

“I can’t bend or twist, because my spine will move out of place.”

These are common statements that I hear as a physical therapist every day.  Often times, our spine is viewed as fragile, something to be protected, and a structure that will easily pop in and out of place if moved “the wrong way.”  The reality is that nearly everyone has back pain at some time in their life, and it is now the leading cause of disability in the world.

The Lancet Papers were published in 2018 as the most up to date, current evidence on how to manage this condition, and the results are contradictory to popular opinion.  The papers state that “Low back pain is a complex condition with multiple contributors to both the pain and associated disability, including psychological factors, social factors, biophysical factors, comorbidities, and pain-processing mechanisms.”

What does this mean?

Basically, this paper states that your back pain is likely not due to one cause, and therefore, there is no one solution.  Core strength, posture, and any other one variable alone will likely not resolve your symptoms. Pain is a combination of your personal beliefs, everyday stressors, sleep, and eating habits, as well as how well and how much you move.  This also means that there may not be an anatomical explanation for your pain. Just because you are having pain, does not indicate that something is out of place, injured, frail, or broken.  Over 90% of back pain has no known cause.

Imaging will likely not reveal the true culprit of your pain, and is NOT recommended for the majority of cases.  After approximately age 50, everyone has abnormal findings, such as disc herniation, stenosis, or spondylolisthesis, and arthritis has been shown to appear in our 20s.  When we words on imaging reports they may sound terrifying, however they are fairly common, and not to be feared. Your pain may be completely unrelated to these findings as well, since people without pain also display these findings on MRI or x-ray.

If we treated low back pain like the common cold, our outlook would be dramatically different.  Everyone at some point experiences the common cold, but it is typically not feared. We simply adapt for a week or so, drink more fluids, modify our activity, and get more sleep.  Low back pain is much the same, although it feels much more debilitating. With an acute episode of pain, you may have to modify work related tasks or your usual exercise routine, but it does not mean that you should stop moving.  In fact, the opposite is true. Rest or immobilization is almost never indicated.

Another one of my favorite analogies for chronic pain is a sunburn.  Just because you went to the beach and now have reddened and painful areas on your skin, you wouldn’t avoid the sun for the rest of your life.  Sun, while it should be avoided in excess, is not harmful. You may use some aloe, wear an extra shirt, and take simple precautions to avoid making your burn worse.   Avoiding the sun would be much like avoiding bending your spine, it simply cannot and should not be done. Low back pain, as well as chronic pain of any nature works the same way.  

Physical therapy has been shown time and again to reduce the length and reoccurrence of low back pain, reduce the need for opioids, and improve quality of life.


Holly D. Rigney

Doctor of Physical Therapy



Loudoun Physical Therapy

525-B East Market Street, Leesburg, VA 20176

Phone: (703) 443-6700 / Fax: (703) 443-6702


44125 Woodridge Parkway, Suite 280, Lansdowne, VA 20176

Phone: (703) 858-8990 / Fax: (703) 858-8994


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Holly DPT

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