This topic is complicated, but one that I am happy to jump on the soapbox for at any time: You are not your imaging results. I repeat: YOU. ARE. NOT. YOUR. IMAGING. RESULTS.
Okay, so what exactly does this mean?
This means that an MRI, X-RAY, or any other diagnostic test does not have the right to dictate the rest of your life. Imaging should be utilized to gain information and understanding of your body. It should not be a tool used to instill fear or catastrophize a problem.
Now of course, if you are diagnosed with a serious condition via imaging (and I’m so very sorry for that) I am by no means saying to ignore your physician or this information. What I am saying is that certain “diagnoses” that are given after imaging are not a 100% causal link to the symptoms you have been having, nor should not be treated as such.
Here are a few scenarios for us to explore to illustrate my point:
Scenario A: Andrea has a 10-year history of back pain. The pain is severe and debilitating. All imaging is “negative”, meaning it’s perfectly normal according to the three doctors she’s asked. “There’s nothing wrong with your back.”
Scenario B: Jason has had back pain on and off for his whole life. An MRI of the area shows bulging discs. Surgery is recommended and performed. His pain is worse after the surgery although all follow-up imaging shows the surgery was “successful”.
Scenario C: Hannah has no back pain. She gets in a minor car accident and a low back X-RAY is taken as a precaution. It shows severe degenerative arthritis in her spine. She develops worsening back pain over the next few months.
Scenario D: Tina has no back pain. They get an X-RAY as part of a paid research project through a hospital down the street from her school. Their X-RAY shows severe degenerative arthritis and degenerative disc disease at multiple levels in the spine. They continue to live a healthy, active lifestyle without a problem.
So what’s up with that?
If imaging were the only answer to accurate diagnosis of pain how could there be so much variability in the aftermath?
All of these scenarios were “made up” but based on various personal and clinical experiences.
Let’s take a little closer look at each scenario.
Andrea – 28, female, history of asthma, allergies + IBS
Andrea has dealt with very real pain, for a very long time. The only thing she hasn’t been able to get is an answer as to what is causing her pain. After three rounds of PT, and multiple injections, a doctor suggests repeating her MRI. The last one she had was almost a decade ago. The doctor presents her “normal” imaging results expecting her to be relieved. Andrea bursts into tears, frustrated that she once again has spent hundreds of dollars and hours on diagnostics with no answers to her pain. The doctor prescribes her an anti-depressant. Andrea accepts, because she’s at a loss at this point anyway.
Andrea’s imaging results were normal because her pain is “invisible”. This is common with chronic pain because it is often coming from the nervous system. This cannot be visualized on an MRI or X-RAY. The nerves in her low back became highly sensitive after a back spasm during a basketball practice in college. This was worsened by high levels of inflammation in Andrea’s body due to a high concentration of processed foods in her diet. The pain got even worse after years of working in a job she hated.
The anti-depressants helped a little because they had a chemical effect on her nervous system. Unfortunately, the meds made her feel sleepy so she eventually stopped taking them and her pain continued.
Jason – 31, male, wants to get back to lifting weights
Jason’s surgeon assured him that his pain was due to the bulging discs that showed up on his MRI. After all his pain was in his low back and radiated down the back of his right leg, which is classic for this type of injury. Jason used to be a competitive power lifter, so it made sense that he would have sustained this type of injury by lifting such heavy weights.
After the surgery, Jason had searing pain in his back around where the incisions were made. Pain started to radiate up his back as well. The portions of the discs that had been “bulging” or thought to be pressing on the nerves were gone, so his surgeon was not sure how he could possibly still be having pain.
So why is Jason’s pain worse? Well, it was actually originating from his fascia, the connective tissue between the skin and the muscles. By cutting through the fascia in his low back during surgery, it became further disrupted. This resulted in more burning and radiating pain. Fascial pain can closely mimic nerve pain and is often mistaken for such. Jason eventually found a PT trained in myofascial release by chance and gave it a go. After several months of gentle hands-on treatment his pain was drastically reduced and he returned to his strength training routine.
Hannah – 29, female, works as a receptionist
So is Hannah a faker? Is she just looking for insurance reimbursement or time off work? No, Hannah really is in pain. But she wasn’t before the X-RAY. So what happened? After discussing her imaging results, Hannah’s physician recommended that “she should be careful with her back” since it is loaded with a lot more arthritic changes than typical of someone her age.
Hannah decides to stop indoor rock climbing and now is careful when lifting anything. She begins to fear that she will hurt her back. Her back begins to ache as she sits on her outdated desk chair all day, wincing every time she stands up.
Then one day as she was bending down to pick up a pen she dropped, she got a shooting pain in her low back and couldn’t move for the next several days. This sparked a lifetime struggle with low back pain that could have been prevented with a more thoughtful discussion of her imaging results.
Tina- 30, non-Binary, third year pt student
So, Tina’s imaging shows the same results as Hannah (actually maybe a little worse). But they don’t have pain after finding out these results. What gives? Arthritis is supposed to hurt isn’t it? Just like Hannah, Tina had been living a healthy, active lifestyle with “abnormal” imaging results. Many, many people are completely pain free despite having “conditions” in their back that modern medicine believes are common drivers of pain.
The difference here is that Hannah transitioned to a life of fear and avoidance after being advised on these negative results. Tina however was in physical therapy school and realized that having degenerative changes in the back can be normal. They realized they shouldn’t worry because they are living their best life and have no experiences with back pain.
Imaging is not bad. It is a useful tool.
But it should be treated as a tool, and not relied up to dictate every move you make and the relationship you have with your body. Our bodies are strong and resilient. When we are in pain we often forget that, feeling vulnerable and fragile. Use the information gained from imaging as a piece of the puzzle, but not as absolute truths. Find physician’s who will explain the results in a compassionate way and not fill you with unnecessary fear. Seek other opinions as needed. Focus on what you can control like the thoughts and foods you feed your body.
Above all else, try to stay positive even when faced with tough stuff.