Positive MRI Findings – A Problem or Just Part of Aging?

Medical imaging has revolutionized healthcare. The ability to view internal structures in a non-invasive way has allowed physicians to be better informed about diagnoses, non-surgical treatment options, and when surgical intervention may be necessary. While these visual tools may offer useful clinical findings to a physician, it is worth noting that sole reliance on imaging findings for diagnosing musculoskeletal injuries is not supported by evidence. Research continues to outline a relatively high prevalence of positive imaging findings in asymptomatic populations, calling into question the reliability of positive findings in symptomatic patients.

Anyone who has worked in healthcare, particularly in the orthopedic setting, has likely heard the following phrase, “My MRI showed I have degenerative disc disease and a bulging disc.” Sounds frightening doesn’t it? Anything degenerative, by definition, is likely to get worse…right? Many patients hear this diagnosis and assume, often incorrectly, that they are doomed to a life of pain and progressively worsening symptoms. What if I was to tell you that many of these degenerative changes show up in asymptomatic individuals? Furthermore, what if I was to tell you that in some studies, the presence of positive imaging findings (like bulging discs) actually reduced the probability of experiencing symptoms ¹? Both scenarios sound unlikely. But they’re true! A systematic literature review² (one of the highest standards of research) evaluated 33 research articles, assessing imaging findings for 3,110 asymptomatic individuals. It was established that 37% of 20-year-olds and 96% of 80-year-olds demonstrated disc degeneration. Furthermore, disc bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. These types of studies are not just limited to the lumbar spine. Similar studies have shown the same type of results for the hip. A 2012 study³ demonstrated that MRI’s of asymptomatic participants revealed abnormalities in 73% of hips, with labral tears being identified in 69% of the joints.

So what does this suggest? It suggests that these changes to structures (bone, cartilage, discs, etc.) often occur as a normal result of “wear and tear” or aging, and that direct correlation between these “positive findings” and the individual subsequently experiencing pain does not exist. In short, finding changes on medical imaging is common, particularly as an individual ages, but does not mean that the individual will experience pain as a result. Yet, how often do you hear healthcare providers simply state “Well, due to findings on your MRI, it’s unlikely that physical therapy will help.” Or “You’ll just have to live with it, considering you have these degenerative changes.” This simply isn’t true!

The fact of the matter is, despite how useful medical imaging may seem, there is no substitute for a good physical exam and history. Long before reliance of imaging became the norm, healthcare providers focused on a detailed history, supported by a thorough physical exam, to rule in or rule out various diagnoses. This skillset is crucial when establishing what tissue may be involved in the patient’s symptoms. So what’s a current impediment to a healthcare provider performing a good physical exam and history? It takes time; a commodity that many healthcare providers do not have.

Luckily for our patients, Results Physiotherapy’s physical therapists, by nature of our extensive training and patient-centric scheduling practices, do have time for a thorough exam! Our PT’s are trained to use all evidence, including a thorough history and physical exam, to guide them towards which tissues/structures that may be to blame for a patient’s symptoms. It is goal of the evaluation to “recreate” the patient’s familiar symptoms, so that the therapist can utilize manual therapy and modalities to ease symptoms, while prescribing exercises to strengthen, stretch, glide, or unload. By finding the true source of their symptoms (vs. what medical imaging may suggest), therapists are able to impact symptoms quickly and without medications, injections, or surgeries. Additionally, Results PT’s can use treatment time to focus on education. Reshaping a patient’s opinion of pain or what MRI findings may actually mean (ex. how common they are, no correlation between severity of symptoms and severity of findings, etc.) can all help with the psychological factors that contribute to pain. Finally, should there be concerns over clinical findings after a thorough physical exam, or lack of progression after 3 or 4 visits, PT’s can coordinate with other healthcare providers to consider next steps (advanced imaging, injections, etc.)