Why doesn't my MRI match my symptoms?

This comes up constantly, and it goes both directions. Some patients are in real, significant pain but get told their MRI "looks fine." Others get an MRI report full of alarming-sounding findings — degeneration, bulges, arthritis — despite having little or no pain at all. Neither situation means something is being missed or that the pain isn't real; it means imaging and pain simply don't map onto each other as cleanly as most people assume.

Disc bulges, degeneration, and other "abnormal" findings show up constantly on the MRIs of people with zero back pain, especially as people get older — they're frequently just part of normal aging, not proof that a given finding is what's actually causing someone's symptoms. On the other side, some genuine pain generators — facet joint irritation, SI joint dysfunction, early nerve irritation without significant structural compression, myofascial pain — don't always show up clearly on standard imaging at all.

This is exactly why Dr. Foster doesn't treat an MRI report by itself. The image is one piece of information, weighed alongside a detailed history, a physical exam, and — when the picture is still unclear — diagnostic injections that test whether a specific structure is actually the source of the pain. The Low Back Pain overview goes into more depth on how that diagnostic process actually narrows things down.

If your MRI and your symptoms don't seem to line up, that's a reason to dig further into the diagnosis, not a signal that nothing can be done — or that the pain isn't real.