This is one of the most common stories in my practice. Someone lives with low back pain for six months, gets an MRI, receives a report saying "no significant pathology" — and is left alone with the pain and the feeling that nobody believes them.
What a scan actually shows
An MRI sees structure very well: discs, bones, ligaments, tumours, inflammation. It does not see how a muscle works. And back pain in most cases is exactly about work: one muscle stopped switching on, its neighbour took the load, and a few months later it gave up.
The reverse is also true and even more interesting. Studies show that bulging and herniated discs are found in a large share of people who have no pain at all. A finding on a scan therefore proves nothing by itself — what matters is whether it matches the clinical picture.
What to look for instead
Functional causes of back pain tend to look like this:
- switched-off glutes — the lower back does their job;
- a stiff thoracic spine — the lower back rotates for two;
- weak deep stabilisers — the spine gets no support from inside;
- shortened hip flexors after years of sitting — the pelvis tilts and the lower back stays under tension.
None of this is visible on an MRI. All of it is visible in muscle testing and in a careful look at how you move.
What to do about it
If the scan is clean and the pain is real, that is good news rather than a dead end. Functional problems are considerably easier to fix than structural ones. The order is usually: find the switched-off link, release the overloaded one, bring the weak muscle back to work and lock it in with a short daily programme.
And yes, still show the scan to a specialist — just not as the single source of the answer, but as one part of the picture.