Do I Really Need Imaging for My Back and Why It Might Not Explain Your Pain

Do I Really Need Imaging for My Back and Why It Might Not Explain Your Pain

A Physiotherapist’s Perspective from Avenue Physio in Downtown Calgary

Back pain can be frustrating. One of the very first questions most people ask is:

“Should I get an X-ray or MRI to find out what’s wrong?”

Many people do eventually have imaging ordered through their family doctor or a specialist. And just as often, they’re told:

“Everything looks normal.” or “You’ve got some wear and tear.”

Yet the pain is still very real. And this is often the most confusing part. If the scan looks “okay,” why does it still hurt? And what are you supposed to do next?

At Avenue Physio, we see this situation every day. And here’s the most important thing we want you to know right from the start:

Back pain isn’t always a simple reflection of what shows up on a scan.

Let’s unpack what that really means and when imaging actually helps.

 

Myth #1: If My Back Hurts, Something Must Be Damaged

This is one of the strongest beliefs people carry. But large imaging studies show a very different story.

  • Up to 80 to 90 percent of people with no back pain at all have disc bulges, disc degeneration, or joint wear and tear visible on MRI.
  • At the same time, many people with significant back pain show no serious structural damage on scans.

These so-called abnormalities are often normal, age-related changes, not the direct cause of pain.

Pain is not a direct measure of tissue damage. Pain reflects how sensitive and protective the nervous system has become.

PHOTO #1

Myth #2: A “Normal” Scan Means My Pain Isn’t Real

This belief causes huge fear, frustration, and self-doubt. But large population studies tell a very different story.

  • Around 90 to 95 percent of people with low back pain are classified as having non-specific low back pain. This means their pain cannot be confidently pinned to one specific damaged structure or disease on a scan, even though their spinal tissues may still be sensitive.
  • Many people in this group have scans reported as normal for age or showing only age-related changes, yet they still have real limits in movement, muscle guarding, and nervous system sensitivity.

Pain is a real physiological experience even when a scan does not show one clear cause.

A normal or non-specific scan does not mean:

  • The pain is imagined
  • You are exaggerating
  • Nothing can be done

It means something much more hopeful. There is no serious disease or major structural damage preventing recovery. That allows us to safely focus on the factors that actually change pain over time.

 

Myth #3: Imaging Will Tell Me Exactly What’s Causing My Pain

This is one of the most persistent myths in healthcare.

  • Imaging findings explain only about 10 to 15 percent of a person’s pain experience in most cases of non-specific low back pain.
  • The severity of scan findings correlates poorly with pain intensity, disability, or long-term outcomes.
  • Fear created by scan language such as degeneration, disc disease, or arthritis is strongly associated with:
    • Higher pain levels
    • Greater disability
    • Slower recovery

Most back pain is influenced by a combination of:

  • Local tissue sensitivity
  • Nervous system sensitivity
  • Guarding and stiffness
  • Strength and conditioning capacity
  • Sleep quality
  • Stress load
  • Beliefs about damage and fragility

A scan cannot measure any of those.

PHOTO #2

So When Do You Actually Need Imaging?

In many cases, imaging is not needed early on.

Imaging becomes important when there are red flags such as:

  • Significant trauma
  • Progressive neurological weakness
  • Suspected fracture
  • Signs of infection or serious disease
  • Pain that does not behave like typical mechanical back pain

This is why a detailed physical assessment always comes first. It tells us:

  • Whether imaging is actually necessary
  • What type would be appropriate
  • What we are truly looking for on the scan

Why Your Back Can Hurt Long After Tissues Have Healed

In many people with persistent back pain, the issue is not ongoing tissue damage. It is an overprotective nervous system.

This sensitivity can develop after:

  • An injury
  • A flare-up
  • Stress
  • Long periods of tension
  • Poor sleep
  • Fear around bending, twisting, or lifting

Your back may feel:

  • Fragile
  • Locked
  • Easily irritated
  • Threatened by movement

But this sensitivity is changeable.

 

What Actually Helps When Imaging Is Normal or Shows “Wear and Tear”

At Avenue Physio, sustainable recovery focuses on three key pillars.

1. Understanding Your Pain

We take time to explain:

  • Why it hurts
  • What is being protected
  • What movements are safe
  • What scan findings actually mean

For many people, understanding alone begins to calm symptoms.

2. Restoring Confident Movement

We gradually reintroduce:

  • Bending
  • Lifting
  • Rotation
  • Sitting tolerance
  • Walking
  • Daily activity

Movement is medicine when it is specific, guided, and progressive.

3. Rebuilding Strength and Capacity

Long-term change depends on:

  • Trunk strength
  • Hip control
  • Endurance
  • Load tolerance
  • Functional movement patterns

This is what breaks the recurring pain cycle.

Manual Therapy

What About Structured Programs Like GLA.D Back?

For people with persistent or recurring back pain, we also offer the GLA.D Back Program. This is a research-supported education and exercise program designed to:

  • Reduce fear around movement
  • Improve strength and confidence
  • Restore function
  • Improve long-term outcomes

 

The Most Important Thing to Know

If your scan is normal or shows age-related changes and your back still hurts, that does not mean:

  • You are broken
  • You are weak
  • You are destined for surgery
  • You just have to live with it

It means your system needs the right movement guidance, education, and progressive loading, not more fear.

 

How Avenue Physio Approaches Back Pain

At Avenue Physio in downtown Calgary:

  • Every session is one on one with a registered physiotherapist
  • There are no assistants
  • There is no double booking
  • You receive clear explanations
  • Hands-on treatment when needed
  • Progressive, individualized exercise
  • Function-focused care

We do not just treat pain.  We help you understand it, retrain it, and move past it confidently.

 

Ready to Take the Next Step?

If you have been wondering whether you need imaging for your back, or you already have a scan and still feel stuck, we are here to help.

Book your one-on-one physiotherapy assessment today.

Previous
Next