So you have an MRI. Now we have THE answer!
If you have ever visited me or heard me speak on imaging - then you will have heard my rants on the use and abuse of imaging in medical diagnosis. There is even a term for it. VOMIT - victims of medical imaging technology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126156/
The allure is powerful - "a picture tells a thousand words" we are told. Well sometimes a thousand words is too much!
Here we have a small but informative study which demonstrates the subjectivity of image interpretation. All clinical investigations have elements of subjectivity in their interpretation.
An area of practice that I am particularly passionate about is communication of imaging results. Its absolutely amazing how powerful what is communicated to a patient (and how) - especially in regards to diagnostic imaging results. The patient that walks in armed with scans or xrays from 10 years ago exclaiming "I HAVE A DISC BULGE!" In my head I think how can I possibly undo this belief system...? People literally carry these pathology labels around with them for life. So strong is our desire to know, see and label pain in our body.
Other studies have demonstrated the very high degree of false positives. https://www.ncbi.nlm.nih.gov/pubmed/25584950 - Nakashima et al. demonstrated this in their cervical spine study
"Most subjects presented with disc bulging (87.6%), which significantly increased with age in terms of frequency, severity, and number of levels. Even most subjects in their 20s had bulging discs, with 73.3% and 78.0% of males and females, respectively. In contrast, few asymptomatic subjects were diagnosed with SCC (5.3%) or increased signal intensity (2.3%). These numbers increased with age, particularly after age 50 years. SCC mainly involved 1 level (58%) or 2 levels (38%), and predominantly occurred at C5-C6 (41%) and C6-C7"
Get that! 73% of 20 year olds with no neck pain had disc bulges on MRI and 87.6% of the 1200 participants had disc bulges and no neck pain.
What does all of this mean? Just because you have xyz pain and an MRI or xray with "wear and tear, disc bulges, degeneration etc etc" - please consider obtaining a clinical diagnosis (also very subjective) from a provider that is going to move your focus from pain and imaging results to movement and function based outcomes.
There is definitely an art, a skill, involved in unpacking, counselling and educating people about their bodies and the lack of support for the use of imaging in the vast degree of spinal problems. Sure imaging has its place but as I like to say though - there is no image that says - here is your pain!