Why Does My MRI Scan Say Everything Is Normal, But I’m Still in Pain?

You’ve had the MRI scan. You’ve waited weeks for it. You’ve opened the report with a mixture of hope and dread.

And then your doctor or health professional declares the unthinkable - despite being on meds all day and barely able to move, you are in fact completely fine and just like that, you become a solved problem and what happens going forwards is you will just get better - just like that.

“No significant abnormality detected - normal for age”

At this point, most people feel confused, dismissed, or quietly furious. Some start wondering if the pain is “in their head”. Others are told, often unintentionally, that because the scan looks normal, there must be nothing wrong.

As a advanced musculoskeletal physiotherapist, I see this scenario every single week. And I’ll be blunt from the start:

A “normal” MRI scan does not mean “no problem”. It certainly does not mean “no pain”.

Let’s unpack why scans frequently fail to explain pain, what they can and can’t tell us, and what actually matters when you’re trying to get better.

What Medical Scans Are Actually Designed to Do (And What They Aren’t)

MRI, CT and X-ray scans are brilliant tools — when used for the right reasons.

They are designed to identify:

• Fractures

• Tumours

• Infections

• Severe structural damage

• Significant nerve compression

• Serious pathology that needs urgent medical input

They are not designed to:

• Explain most everyday musculoskeletal pain

• Predict who will hurt and who won’t

• Measure tissue sensitivity

• Assess movement quality

• Identify dynamic overload, poor recovery, or pain system sensitisation

In short, scans are good at spotting danger.They are far less good at explaining discomfort, persistence, or actual dysfunction.

This distinction is critical — and rarely explained properly.

Why Pain and MRI Scans Often Don’t Match

One of the most robust findings in modern pain science is this:

You can have pain without visible tissue damage. You can have visible tissue changes without pain.

Large population studies repeatedly show that people with no pain at all often have disc bulges, tendon changes, cartilage wear and joint degeneration on scans.

For example:

• An estimated 30% of pain-free adults in their 30s have disc bulges on MRI

• This rises to over 60% by age 50

• By later adulthood, “abnormalities” are more common than not

Yet these people feel fine.

This data comes from landmark studies which reviewed thousands of MRI scans in people with no back pain at all.

Pain Is Not a Tissue Damage Meter

This is where the traditional model breaks down.

Pain is produced by the nervous system, not directly by tissues. Tissue injury can contribute to pain, but pain itself is an output, influenced by multiple factors including:

• Past injury history

• Load and recovery balance

• Sleep quality

• Stress levels

• Beliefs about damage

• Fear of movement

• Conditioning of the nervous system over time

When pain has been present for weeks or months, the nervous system often becomes protective and over-responsive, even when tissues have healed.

This concept is well established in modern pain science and explained in detail by Moseley & Butler in Explain Pain and numerous peer-reviewed papers.

“But Surely If Something Hurt, It Would Show on a Scan?”

It’s a reasonable assumption — and completely understandable.

The problem is that many pain drivers don’t show up structurally, including:

• Tendon overload without tearing

• Early reactive tendinopathy

• Joint irritation without cartilage loss

• Muscle guarding and altered recruitment

• Loss of movement confidence

• Reduced load tolerance

• Neural sensitivity

None of these require “damage” in the traditional sense — but all can be profoundly painful.

Think of pain less like a warning light showing a broken part, and more like a car alarm that’s become overly sensitive.

Nothing is stolen.The car isn’t damaged.But the alarm still won’t shut up.

When Scans Actually Make Things Worse

This might surprise you, but scans can sometimes increase pain and disability, not reduce it.

Studies show that people who receive imaging reports with poorly explained “abnormal findings” often:

• Move less

• Fear activity

• Expect damage

• Recover more slowly

• Seek more medical interventions

This is called iatrogenic harm — harm caused unintentionally by medical processes. Those of us clinicians that have been around for longer than they care to admit will see all to often the detrimental effect Kinesiophobia (the fear of movement), often accompanied by subsequent catastrophisation which basically entails people imagining the worse outcomes possible, rather than more logical one.

A classic example is someone being told they have “degenerative disc disease”, without context. That phrase sounds terrifying, yet it often describes normal age-related change, not a disease process.

Why “Nothing Is Wrong” Is the Wrong Thing to Say

When a scan doesn’t show serious pathology, the correct conclusion is:

“There is no dangerous or surgical problem here.”

It is not:

“There is nothing wrong.”

Pain is real. The experience is real. The impact on your life is real.

A good clinician explains:

• What the scan rules out

• Why pain can still exist

• What can be done next

• How recovery actually happens

A bad system, under pressure, often stops at “scan normal — discharge”.

This is where many people fall through the cracks.

Why This Is Especially Common in the NHS

It’s important to be fair here.

The NHS is outstanding at:

• Emergency care

• Life-threatening pathology

• Surgical intervention

• Serious disease management

• 
  

But MSK pain sits in an awkward middle ground.

Time pressures, referral pathways, scan-led decision making and sheer workload mean that:

• Appointments are short

• Explanations are rushed

• Follow-up is limited

• Rehab is often under-resourced

• 
  

This is not due to lack of clinician skill — it’s system pressure and red tape, not competence.

Unfortunately, pain that doesn’t fit neatly into a scan result often gets labelled as “non-specific” and quietly sidelined.

What Actually Explains Pain When Scans Don’t

When scans don’t give answers, clinical assessment becomes everything.

A proper MSK assessment looks at:

• How you move, not just how you look lying still

• Load tolerance over time

• Symptom behaviour patterns

• Strength, control and coordination

• Sensitivity of tissues and nerves

• Flare-up triggers and recovery response

These factors are dynamic — they don’t show up on static imaging.

This is why experienced physiotherapists often make more sense of pain without needing scans at all.

So Should You Ever Have a Scan?

Sometimes — yes.

Scans are appropriate when:

• Red flags are present

• Serious pathology needs ruling out

• Symptoms are worsening despite appropriate care

• Surgical decisions are being considered

They are not automatically required for:

• Most back pain

• Most shoulder pain

• Most tendon pain

• Most long-standing MSK issues

• 
  

In fact, UK NICE guidelines explicitly recommend against routine imaging for non-specific low back pain.

Why the Right Physio Makes the Difference Here

When scans don’t explain pain, you need someone who:

• Understands pain science

• Can interpret scans properly (not worship them)

• Assesses movement, not just structure

• Has the time to explain what’s happening

• Can build a plan that restores confidence and capacity

The Bottom Line

If your scan says everything is normal but you’re still in pain, it does not mean:

• You’re imagining it

• You’re broken

• Nothing can be done

• You just have to live with it

It means:

• Serious pathology has likely been ruled out (good news)

• The explanation lies in function, sensitivity and load — not damage

• With the right approach, improvement is very realistic

Pain is not always visible on a screen.But it is always understandable — if someone takes the time to look properly.

Want Help Making Sense of Your Pain?

If you’re stuck in scan-limbo and want a proper explanation, not a shrug and a discharge letter, an advanced MSK physio assessment can often the missing piece.

No scare tactics. No scan worship. No nonsense.

Just clear reasoning, honest guidance, and a plan that actually makes sense.