What Your MRI Might Be Getting Wrong About Your Pain
I wish I could share this photograph, but it may cause some embarrassment, so I will help you imagine it.
The setting is a beautiful beach where we are taking family pictures following the marriage of my wife's youngest brother. The whole family is huddled together tightly to fit everyone into the photo, with the new bride and groom standing in the center.
You only have to pause on the image briefly to see the open hand of the groom's new brother-in-law reaching out toward the bride’s chest.
It's an action fit for an episode of Jerry Springer.
The picture would make you go wide-eyed, wondering what that man was thinking—but some context changes everything.
Just before the incriminating photo, the photographer called for a big group hug, and the poor guy was simply following orders.
And of course, we’ve now all had a good laugh about it.
What This Has to Do with MRIs
I thought about this story as I started writing about our fascination with MRIs, which are often used to diagnose injuries and conditions—especially musculoskeletal problems like shoulder pain.
These highly detailed images offer a glimpse into your anatomy.
I’ll gladly accept these advancements in medical technology for their potential good. But we also need to recognize they are not without consequences.
Like the incriminating wedding photo, they don’t capture the full context around an injury.
Yet we often treat MRI findings as gospel when managing pain—and that’s where problems begin.
Normal Variations and “Findings” That Don’t Matter
As Dr. Gilbert Welch points out in Overdiagnosed, the sensitivity of modern imaging allows us to detect abnormalities that may never cause symptoms—or may resolve on their own.
This means people can end up receiving unnecessary tests and treatments based on results that aren’t clinically meaningful.
MRIs can reveal incidental findings—abnormalities that may not be related to your symptoms at all, or that may improve naturally over time.
Several studies have shown “wear and tear” in people who are completely pain-free.
That’s a problem.
Because once something shows up on an image, it’s hard to ignore—even when it shouldn’t drive decision-making.
Cost, Resources, and Anxiety
MRI scans are expensive.
Unnecessary imaging doesn’t just strain the healthcare system—it also impacts the patient directly.
Money spent chasing findings is money not spent on treatment that could actually improve the condition.
Then there’s the psychological cost.
People fixate on MRI results and often assume the worst, even when the clinical picture suggests a good prognosis.
That anxiety can actually slow recovery.
The Takeaway
MRIs are powerful tools—but they are not infallible.
And they should never be the sole determinant in how an injury is treated.
Like that wedding photo, they show a moment in time—but not the full story.
If you’re dealing with pain, the image is just one piece of the puzzle.
Not the whole picture.
