Why Your MRI Looks Fine But the Pain Is Real — A Physical Therapist Explains
- Bobby Geevarughese
- 7 days ago
- 3 min read
When the MRI Comes Back Normal
Is this you? You show up to the emergency room or your doctor in severe pain. They order an MRI to rule out structural damage — and to your dismay they find nothing wrong. You ask what's next. At that point there is only so much they can offer. Medication to manage symptoms. And if the pain persists, an endless list of treatments that may not solve the root problem. The pain becomes chronic. You get stuck in a never-ending loop of trying to find a solution that never quite works.
MRIs Are Valuable — But They Have Limits
MRIs are important for ruling out structural issues. I have worked in a hospital for over 13 years and have seen many patients whose pain did have a structural cause. But I have also seen countless patients whose MRI showed nothing — and yet their pain was very real.
Here is why: MRIs show structural damage but cannot show how your nervous system is interpreting signals from your body. That difference changes everything.
The Research That Changed Everything
Numerous studies show that MRI findings often do not correlate with pain. A landmark 2015 review published in the American Journal of Neuroradiology analyzed 33 studies covering over 3,000 people with no back pain and found that disk degeneration was present in 37% of 20-year-olds and 96% of 80-year-olds — most with zero symptoms.
For patients with knee pain, a study published in the New England Journal of Medicine found that over 60% of people with no knee pain had meniscus tears on MRI.
For rotator cuffs, over 40% of people with no shoulder pain had tears.
The conclusion: imaging findings must always be interpreted in the context of the person — not in isolation. A finding on an MRI does not automatically mean that finding is causing your pain.
What Is Actually Causing the Pain
This is where we need to look at the nervous system. One specific type of pain worth understanding is neuroplastic pain and central sensitization.
Think of it as an overly sensitive fire alarm system in your body. If you have chronic back pain, every time you turn in bed or bend down to pick something up, the "fire alarm" in your brain thinks you are in danger and triggers pain signals to protect you — even when there is nothing structurally wrong. The brain has become sensitized to those movements and activities through repetition and fear.
I learned about this through my own experience with severe hip pain. Despite being a PT myself and doing 30 sessions with a very good therapist, my pain wasn't improving. When I learned about neuroplastic pain and the fear-movement connection I tried something different — I gradually started facing the movements I had been avoiding. Within one week the pain was gone.
What Actually Helps
This understanding changes everything about how we treat chronic pain. As a PT who has worked with many chronic pain patients I can tell you that massages, exercises, and e-stim often don't solve the problem for this type of pain — because they're not addressing the root cause.
What does help is working directly with the nervous system. This means education about how pain works, gradually facing feared movements to retrain the brain's alarm system, and addressing the emotional and psychological factors that keep the nervous system heightened. This approach is called Pain Reprocessing Therapy (PRT) — and it's the foundation of how I work with every patient.
Healing is possible. I know because I have been there myself — not just once, but many times with many different symptoms. And I have seen it happen for patients who were told nothing more could be done.
Ready to Find Out If This Applies to You?
If your imaging has come back normal but you're still in significant pain, there's a good chance your nervous system is the driver — and that's actually good news, because it means it can change.
I offer a free 30-minute call to discuss whether this approach is right for your situation. No pressure, no commitment — just a conversation with someone who has been where you are.
