Do scans (MRI/X-ray) always explain pain?

When people experience ongoing pain, it’s natural to look for clear answers. MRI and X-ray scans often feel like the ultimate source of truth—something that will finally explain why the pain is there. But in musculoskeletal care, scans don’t always tell the full story of your problem.

Imaging is designed to show structures. X-rays are excellent for looking at bones and joint alignment, while MRIs can show soft tissues like muscles, discs, ligaments, and tendons. These tools are very important when serious conditions are suspected, such as fractures, infections, or major tissue damage. However, the majority of everyday aches and pains are not caused by a single visible structural problem.

One of the most surprising findings in modern research is how common “abnormal” scan results are in people who have no pain at all. Disc bulges, joint degeneration, cartilage wear, and tendon changes appear consistently on scans of pain-free individuals. These findings are often part of normal aging and adaptation to life’s physical demands. Seeing these changes on a scan doesn’t reflect the source of pain.

Pain itself is complex. It is influenced not only by tissue damage but also by how the body moves, how much load it is exposed to, and how the nervous system processes signals. Factors such as muscle weakness, stiffness, poor movement patterns, sudden changes in physical activities, stress, and past injuries can all contribute to pain. Many of these influences don’t show up on imaging, yet they play a major role in how someone feels.

This also explains why pain can exist even when scans appear normal. A clear scan does not mean the pain is imagined or “all in your head.” It simply means that the source of pain is not something imaging can easily capture. These types of problems often respond very well to physiotherapy assessment and management, where treatment focuses on restoring movement, strength, confidence, and function.

In some cases, scans can even complicate recovery and make it worse. Reading scan reports filled with terms like “degeneration” or “wear and tear” can increase fear and uncertainty. When pain is associated with worry or avoidance of movement, symptoms can persist or worsen. Understanding what scan findings actually mean—and what they don’t—is an important part of recovery.

This doesn’t mean scans are unnecessary. They are very useful when symptoms are severe, worsening, linked to trauma, or when surgery is being considered. But for most musculoskeletal conditions, a detailed assessment of how someone moves, what aggravates their symptoms, and how their body responds to activity provides far more useful guidance than imaging alone.

Ultimately, scans are tools to assist diagnosis but not explanations. Pain is rarely caused by one single finding on a report. A physiotherapy approach that looks at the whole person—not just the picture—offers the best path toward understanding pain and improving function.

Alex Chan

Physiotherapist

Disclaimer:  This blog post is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment or if you have concerns about your health.