A Picture Isn't Always Worth a Thousand Words (Or Dollars): Why Your Aches Don’t Always Need an MRI
By: Kelsie Mazur, DPT
You’ve got a nagging ache in your back, shoulder, or knee. You Google it (because of course), and soon you’re convinced something must be torn, herniated, or broken. What’s the next step? Ask your doctor for an MRI, right?
Not so fast…..This week we are talking about imaging and when it is necessary.
MRIs are amazing tools. They give us detailed images of soft tissue, bones, and joints—like a superhero version of X-ray vision. But here’s the catch: they show us everything… including things that don’t matter. Imagine taking a picture of a 20-year-old couch. You’ll see the sagging cushions, a scratch from the cat, a stain from 2016. But the couch still works just fine. That’s what happens with MRIs. They’ll show “issues” in your body that are often totally normal, especially as we age.
MRIs have become the go-to expectation for figuring out what’s “wrong” when pain sticks around. It’s easy to see why they’re high-tech, detailed, and seem to offer a definitive answer. But here’s the truth:
Pain doesn’t always show up on a scan. And not everything on a scan causes pain.
Studies show that up to 60% of people with no pain at all have things like herniated discs, meniscus tears, or rotator cuff fraying on their MRIs. These changes are like wrinkles on the inside—they don’t always mean something’s wrong.
So What Does Matter?
Your story.
Your movement.
Your function.
That’s where a good physical therapist (hi, I’m Kelsie) comes in. At Wattage, we assess how your body moves, not just how it looks on a screen. We’re looking for patterns, compensation, strength, flexibility, and how all the pieces work together. A picture might show a tear, but it doesn’t tell us if that tear is actually causing your pain. MRIs are not bad. They can be incredibly useful, even life-saving in some cases. They give us beautiful, detailed images of muscles, tendons, cartilage, and bones. They help detect fractures, tumors, major tears, or infections. But MRIs show structure, not function. They’re a still photo of your body, not a video of how it moves, compensates, or adapts.
Think of it like this: If your car’s engine is making a weird noise while driving, would you figure it out by just looking at a parked photo of the car? Of course not! You’d need someone to listen to it running and maybe take it for a test drive. That’s what a good physical therapist does with your body.
This might blow your mind, but plenty of people walk around every day with things like:
Herniated discs
Torn meniscus
Rotator cuff fraying
Labral “tears”
…and they have zero pain.
When you come to see a physical therapist, we’re less interested in what your MRI says and more interested in what your body is doing.
We ask things like:
How do you move?
What makes the pain worse (or better)?
Are certain muscles compensating for weaker ones?
Is your pain related to posture, stress, or lifestyle?
Your pain is a story and MRIs don’t do a good job of telling it. They miss the nervous system, muscle coordination, movement patterns, and even psychosocial factors (like stress or fear of movement) that can amplify pain.
When Imaging Is Helpful
Imaging is a powerful tool when used at the right time. We usually consider it if:
There's trauma (like a fall or car accident)
There’s major swelling, numbness, or loss of strength
Symptoms aren’t improving with treatment
Red flag symptoms: night pain, unexpected weight loss, fever, cancer history.
But for most everyday aches, a full movement-based assessment and good ol’ fashioned therapy are the best first steps.
We get it. When your body hurts, you want answers and an MRI feels like it should have them. But often, it just complicates things, showing “abnormalities” that aren’t really the problem, and sometimes even leading to unnecessary worry, surgery, or avoidance of activity.
“Treat the patient, not the picture.” That’s our motto in physical therapy. We look at you, not just your scan to understand what’s happening, what’s causing your pain, and how to get you moving again. So before you push for that MRI, come see us. Let’s figure out what your body really needs..not just what it looks like on a screen.
Did you know that we offer free 1-on-1 injury screens? Wattage Physical Therapy will take an in depth look at your ergonomics, posture, muscle tone, muscle weaknesses, and movement patterns to create a plan for YOU. If this article intrigues you, you can directly email me, Kelsie at Kelsie@wattagept.com. I would be happy to help you start the process of living a life free from pain.