Understanding the Disconnect Between Imaging and Pain
At Central Ohio Spine and Joint, one of the most important conversations we have with patients centers around what their imaging truly means. It’s not uncommon for someone experiencing back, neck, shoulder, or knee pain to come in with an MRI or X-ray report showing degenerative changes or arthritis, and to assume that these findings are the source of their symptoms.
However, modern research has consistently shown that degenerative changes, like disc bulges, osteoarthritis, and joint space narrowing, are commonly found in people with no pain at all. This has profound implications for how we interpret imaging results and how we help our patients understand and manage pain.
What the Research Says About Arthritis in Asymptomatic People
A pivotal 2015 systematic review published in The American Journal of Neuroradiology analyzed imaging findings from thousands of people without back pain. The results were eye-opening:
- Disc degeneration was found in 37% of 20-year-olds and increased to 96% of 80-year-olds.
- Disc bulges were present in 30% of 20-year-olds and up to 84% of 80-year-olds.
- Facet joint osteoarthritis, often implicated in back pain, was found in more than 50% of people over 60—even when they had no symptoms.
Similarly, studies on knee and hip arthritis show that radiographic signs of osteoarthritis are present in many individuals who report no pain or mobility issues. In one study published in The New England Journal of Medicine, researchers found that 85% of people with abnormal knee MRIs were asymptomatic.
These findings aren’t limited to the spine or knees. Shoulder imaging often shows rotator cuff tears in people with no pain, especially as they age. One study found partial or full-thickness rotator cuff tears in more than 50% of asymptomatic adults over 60.
Normal Age-Related Changes vs. Pain-Causing Pathology
So what does all this mean?
Degenerative findings on imaging are often normal age-related changes, much like gray hair or wrinkles. They reflect the body’s natural aging process rather than a specific injury or pain source.
While these findings may correlate with pain in some individuals, they are not always the cause. This is why a diagnosis based solely on imaging can be misleading—and potentially harmful.
At COSJ, we focus on clinical correlation. That means we take into account your history, movement, function, and symptoms, not just what shows up on an X-ray or MRI. Imaging can be a helpful tool, but it should never be the sole determinant of your diagnosis or treatment plan.
Why This Matters for Patient Education
This research plays a huge role in how we educate and empower our patients.
When someone sees the words “degenerative disc disease,” “arthritis,” or “tear” on a report, it’s easy to feel discouraged or fearful. These terms often sound worse than they are and can lead to the belief that movement will cause more damage or that surgery is inevitable.
But the reality is that many of these findings:
- Are common, especially as we age
- Don’t correlate with pain or dysfunction
- Can often be managed conservatively with exercise, strength training, and chiropractic care
By helping patients understand the normalcy of many imaging findings, we reduce fear, improve confidence, and foster active participation in care. This process, known as pain education, is a key component of evidence-based rehabilitation.
How We Incorporate This at COSJ
At Central Ohio Spine and Joint, we use this research to guide informed, patient-centered care. Here’s how it shapes our clinical process:
1. We Educate First
We take the time to explain what imaging really shows—and what it doesn’t. By setting expectations and clarifying normal age-related changes, we help our patients move away from fear-based thinking.
2. We Focus on Function
We prioritize how you move, not just how your joints look. If you’re strong, mobile, and improving—even if imaging shows arthritis—that’s a win. You’re more than your MRI.
3. We Use Conservative Care as First-Line Treatment
Evidence shows that strength training, mobility work, and manual therapy are highly effective in managing joint pain, even in the presence of arthritis. Our team includes chiropractors, physical therapists, and personal trainers who work together to restore function and reduce pain—without unnecessary medications or surgeries.
4. We Set You Up for Long-Term Success
By combining education, rehab, and fitness, we empower patients to take control of their health. Understanding that arthritis isn’t always a problem helps people move more, fear less, and feel better.
Case Example: Knee Pain and “Bone-on-Bone” Arthritis
One of the most common phrases we hear is “My doctor told me my knee is bone-on-bone.”
While that can sound alarming, we’ve seen numerous cases where patients with so-called bone-on-bone arthritis improve dramatically with proper strength training, joint mobility work, and load management.
In fact, studies show that even in people with moderate to severe radiographic arthritis, structured exercise programs can reduce pain, improve mobility, and delay or avoid surgery.
The key is understanding that pain is multifactorial—not just structural. Things like inflammation, joint stability, movement quality, and even psychological factors like fear and stress all contribute to how pain is experienced.
Final Thoughts: Reframing the Narrative Around Arthritis
If you’ve been told that you have arthritis or degeneration on imaging, don’t panic. You’re not broken. You’re not fragile. And in many cases, you’re not even symptomatic from what the imaging shows.
At Central Ohio Spine and Joint, we believe in helping you understand your body, not fear it. Our goal is to shift the conversation from “What’s wrong with me?” to “What can I do to feel better and move forward?”
Arthritic changes are normal. Pain is complex. And with the right approach, you can regain control, rebuild strength, and get back to doing the things you love.
Interested in learning more or starting a plan that focuses on what you can do instead of what’s on your X-ray? Contact us today for an evaluation. Our team is here to help.
Research References
- Brinjikji et al. (2015) – A systematic review analyzing imaging findings in asymptomatic individuals revealed that disc degeneration was present in 37% of 20-year-olds and increased to 96% in 80-year-olds. Similarly, disc bulges were found in 30% of 20-year-olds and up to 84% of 80-year-olds, indicating that such changes are often part of normal aging rather than direct causes of pain. American Journal of Neuroradiology
- Culvenor et al. (2019) – This systematic review and meta-analysis reported that MRI features associated with knee osteoarthritis, such as cartilage defects and meniscal tears, were present in 4%–14% of adults under 40 years and 19%–43% of adults aged 40 and above, even in the absence of symptoms. Mend Colorado+3ResearchGate+3Opal+3
- Horga et al. (2020) – In a study of 230 knees from asymptomatic adults, 97% showed abnormalities on MRI, including meniscal tears, cartilage lesions, and bone marrow edema, highlighting the prevalence of such findings in individuals without knee pain. Movement Performance Centre+3SpringerLink+3PubMed+3
- Boden et al. (1990) – Research indicated that 80% of asymptomatic individuals aged 60 and older had cervical disc degeneration, suggesting that such imaging findings are common and not necessarily indicative of pain. Nature
- Jensen et al. (1994) – This study found that 64% of asymptomatic individuals had intervertebral disc abnormalities, including bulges and protrusions, reinforcing the notion that these findings are often incidental. American Journal of Neuroradiology
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