A research paper in the British Journal of Sports and Exercise Medicine summarised MRI results from multiple studies, in people over the age of 40 who had NO PAIN, i.e. they were ASYMPTOMATIC (1), the results showed:
Lower Back:
- 68-96% had signs of disc degeneration
- 50-84% had disc bulges
Shoulder:
- 55-75% had labral tears
Hips:
- 54% demonstrated labral tears
- 12% had cartilage lesions
Knees
- 43% had cartilage lesions
- 19% showed signs of cartilage lesions
- 37% had osteophytes (bone spurs)
Just to re-highlight these are findings from people who were experiencing NO PAIN!
So what does this mean?
It demonstrates that some things we see on MRI can be just a part of normal ageing, think of them as “wrinkles on the inside”, they can often be red herrings and not the reason for your pain (1).
It also highlights that pain can be far more complex than what we see on an MRI. There is ample research to prove that we can have pain in the absence of any tissue damage or injury and the level of pain we experience can be affected by multiple factors ranging from training load, pain beliefs, levels of fatigue, sleep quality, abdominal obesity, comorbidities such as Crohn’s or Diabetes, mental health and also despondent messages from our health care professionals (2).
For clinicians, a common concern is that when patients see such findings on their MRI report, they start to blame their pain on it, often feeling like it cannot get better or will not get better without surgery. Secondly, patients can become fearful of moving in the false believe that they will cause more damage, creating a downhill spiral of less movement and increasing symptoms.
This is not to say that MRI findings are not valuable, they can certainly demonstrate the cause of the symptoms, this is especially true and pertinent in acute traumatic injuries e.g. MRI findings of a ligament tear after a traumatic knee injury.
Where do we go from here?
To minimise the effect and fear that such abnormal findings can have on patients, the authors of the paper called for clinicians to discuss the findings of MRIs in the context of how these findings can be seen in people with no pain (1). AND as health care professionals we have a responsibility to look beyond the MRI findings and dig a little deeper into our patients lives and history.
Treat the Patient, not the Scan!
References:
- Culvenor, et al., (2021) Infographic. When is abnormal normal? Reframing MRI abnormalities as a normal part of ageing. British Journal of Sports Medicine, 55(13), pp.761-762. [Online]. Available at: https://bjsm.bmj.com/node/123457.abstract
- Caneiro et al (2021) There is more to pain than tissue damage: eight principles to guide care of acute non-traumatic pain in sport. British journal of sports medicine, 55(2), pp.75-77. [Online]. Available at: https://bjsm.bmj.com/content/55/2/75
