When in pain it is natural to seek an explanation for why we hurt. We make our way to the doctor’s office or the physical therapy clinic in search answers. We want to know the reason for our pain and advice on how to eliminate it. Often we end up with a trip to the radiologist in order to get a detailed view of the involved anatomy. MRI’s are taken looking for any sign of tissue/structural damage that we can blame for our symptoms. However, this can prove problematic. Recent research is demonstrating that there is not always a correlation between pain and tissue damage. That is, we can have pain without tissue damage and we can have tissue damage without ever experiencing pain.
Here is what the research has to say:
Exert from: From A Guide to Better Movement by Todd Hargrove
“Common examples of tissue damage without pain are provided by the numerous studies involving MRI examination of joints that are not painful.
Backs: 52% of people with pain free backs had at least one bulging disc or other MRI abnormality. In a similar study, one third of individuals who had never suffered back pain had a substantial spinal abnormality, and 20 percent under the age of sixty had a herniated disc.
Hips: Among pain free hockey players, 70% had abnormal pelvis or hip MRIs, and 54% had labral tears.
Knees: 60% of people with pain free knees, aged 20-68, showed abnormalities in at least 3 of the 4 regions of the knee.
Shoulders: In one study 23% of people with asymptomatic shoulders had a rotator cuff tear. The authors concluded this percentage to be “astonishingly high” and concluded that “rotator cuff tears must to a certain extent be regarded as “normal” degenerative attrition, not necessarily causing pain and functional impairment .” In pain free overhead athletes, 40% of dominate shoulders had findings consistent with partial or full thickness tears of the rotator cuff, as compared to 0% of the non-dominate shoulders. But neither shoulder hurt, and none of the athletes had any pain or problematic symptoms 5 years after the study. “
So if you are worried about the results of your MRI keep this information in mind. What appears damaged on MRI may be a coincidental finding and simply normal age related changes. There is likely another source of your pain, see our previous blog on chronic pain here and look forward to our next blog on the Nervous System and the role it plays in painful conditions.
Jimmy Picard PT, DPT
Jensen et al. (1994) MRI of the lumbar spine in people without back pain. New England Journal of Medicine. 1994 July 14; 331(2): 69-73
Boden et al. (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. Journal of Bone and Joint Surgery of America. 1990 March; 72(3): 403-8
American Orthopedic Society for Sports Medicine (2010).
Beatie et al. (2005) Abnormalities identified in the knees of asymptomatic volunteers using peripheral MRI. Osteoarthritis Cartilage. 2005 March; 13(3): 181-6
Templehof et al. (1999) Age related prevalence of rotator cuff tears in asymptomatic shoulders. Journal of Shoulder and Elbow Surgery Vol. 8, Issue 4, July 1999, 296-9.
Conner, Banks et al. (2003) MRI of the Asymptomatic Shoulder of Overhead Athletes. A 5-year Follow-up Study. American Journal of Sports Medicine September 2003, Vol 31, No. 5, 724-7.
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