My MRI seems to show a lot of damage. Should I be worried?

You went for the MRI because some joint has been hurting. Perhaps you have worsening knee pain as you go downstairs or some pain running down your leg or maybe your shoulder hurts when you reach overhead. Whatever the reason, you opted for an MRI to “see what’s going on” with that painful joint. You laid down in that narrow tube kept perfectly still and endured the loud banging for 30- 40 minutes. A couple of days later you got the MRI report and it is filled with a bunch of terrifying sounding words like herniation, desiccation, degeneration, derangement, defect, stenosis, spondylosis, osteophyte, or something similar. Now you are concerned. Maybe this is worse than you thought. Is it time to worry? Let’s break it down. Below are the things I’m looking for when reading an MRI report:

Unexpected or dangerous findings First and foremost I want to ensure that there are no potentially dangerous or life-threatening findings. These would include a tumor, a fracture, or necrosis (tissue death from poor blood supply). These findings are very rare and are often found incidentally. If discovered, your physician would have contacted you right away because they need to take immediate action.

Clinical Correlation These are findings that can be directly related to your symptoms. Issues with the bones, discs, or nerves can directly be related to the symptoms you present with. For example, if you are having pain in the right leg in the area the L4 nerve travels to and the MRI shows that there is pressure on that right L4 nerve root, the findings of the image would correlate with the symptoms you have (the clinical findings). Whenever you can find a strong clinical correlation it gives you and your healthcare provider a pretty good idea of what is causing your pain and the best strategies to treat it.

Non-Clinical Correlation Very often an MRI will reveal some amount of tissue damage that does not necessarily relate to your symptoms. So there is tissue damage but it is asymptomatic. That damage was likely there before you started to have pain and is not contributing to the pain you are currently having. These findings are noteworthy but should not be cause for concern. Sometimes the extent of degeneration shown by an MRI can be quite severe, but the patient has little or no pain. In these cases, you are better off just forgetting about the findings and moving forward with your life. Very often there may be findings that may not be contributing to your symptoms. Again, these should be noted and discussed with your physician or PT, but are not worth losing sleep over. In many cases, it may be difficult to know for sure if MRI findings are truly the cause of your pain. In these cases, I suggest taking conservative measures and being patient to see how your symptoms develop. You don't want to rush into surgery or a procedure to address an issue that was never really the root cause of your pain to begin with.

Normal Wear and Tear As you go through life it is normal for tissue to break down to some degree. In fact, it would be abnormal to have a “perfect” MRI well into adulthood. Your physician or PT should be able to distinguish normal wear from abnormal damage. These findings would very likely have been present before your symptoms started and will continue after they go away. Remember, the report is going to highlight everything they find, regardless of importance. So just because something shows up on the image does not make it meaningful for your health and ability to live your life.

Recent studies have shown that when completely asymptomatic adults received an MRI over 50% had some “positive finding” in their images. That means that for people who have absolutely no symptoms over half have some form of tissue damage. This tells us that tissue damage in and of itself doe not necessarily cause symptoms. It also shows that “clean” MRI is less common than positive MRI even in people with no pain at all.

So when you read that report with the scary medical jargon, don’t panic. Studies have shown that worrying thoughts about MRI findings actually lead to increased symptoms of pain and disability. Symptoms worsen from the stress and anxiety of the worry and not your actual physical condition. Consult with your healthcare provider so you can put those findings into context and take the best next steps for your health.