Your MRI Shows a Herniated Disc. That Doesn’t Mean It’s the Cause of Your Back Pain

A physical therapist in Japan walks through the research on MRI findings in people with no pain — back, knee and shoulder — and how to read your own scan results without fear

This is an English version of an article I first published in Japanese. It was translated with the assistance of an AI writing tool.

You go to an orthopedic clinic with back pain and get an MRI. Back in the exam room, the doctor points at the cross-section of your spine on the screen and says:

“See here? The disc is bulging out a little. That’s a herniation.”

At that moment, many people come away with one feeling: “My back is broken.”

From then on, lifting anything heavy feels scary. Every time you bend forward, that image flashes through your mind. When someone suggests exercise, you think, “Is it really safe to move with a herniated disc?”

As a physical therapist in Japan, I regularly meet people who stopped moving after they saw their scan.

It’s the same with knees. “Your cartilage is worn down.” “Your meniscus is damaged.” With shoulders, it’s “Your rotator cuff is torn.” And at a health checkup: “Your bone density is on the low side.” “This number is above the reference range.”

Being told your test is “abnormal” is important information, of course. But is that “abnormality” really causing your symptoms right now? Should it even be called abnormal? If you take in the result without sorting this out, you can end up more afraid than you need to be — or, the other way around, miss signs that really do need attention.

In this article, focusing on scans of the lower back, knee and shoulder, I’ll cover:

• How often scans of people with no symptoms show “abnormal” findings
• Why some people have “abnormal” findings but no pain
• Whether that makes scans useless (it doesn’t)
• How to live with your test results

I’ll go through the research one study at a time.

One thing up front: this is not an article saying “you don’t need scans” or “scans are useless.” I generally do recommend getting checked. This is about how to read your results correctly.

The short version: Scans of people with no back pain routinely show disc changes — in about a third of people in their 20s and almost 9 in 10 people in their 60s. The same is true for knees and shoulders. A finding on your scan is not proof that it’s causing your pain. Scans matter most for ruling out serious problems, and your symptoms, what you can do, and how things change over time tell you more than one image.

This article is general health information. It is not meant to diagnose or treat any condition. If you have symptoms, please see a doctor.

“No findings” is the rare result: what lower-back MRIs have taught us

Let’s start with the lower back, where the research is the most developed.

In 2015, an important review was published in an American radiology journal [1]. A research team from the Mayo Clinic and the University of Washington gathered 33 studies in which CT or MRI scans were taken of people without back pain — 3,110 people in total. They then summarized, by age group, which findings showed up and how often.

The key point is that everyone in these studies had no back pain. So these numbers show how often “abnormalities” appear in the backs of people who don’t hurt.

Here are the results.

Disc degeneration (the disc drying out or getting thinner)

• 20s: 37%
• 40s: 68%
• 60s: 88%
• 80s: 96%

Disc bulge (the disc bulging out all around)

• 20s: 30%
• 40s: 50%
• 60s: 69%
• 80s: 84%

Disc protrusion (close to what people call a herniation)

• 20s: 29%
• 40s: 33%
• 60s: 38%
• 80s: 43%

Facet joint degeneration (wear in the small joints at the back of the spine)

• 20s: 4%
• 40s: 18%
• 60s: 50%
• 80s: 83%

Let me say it again: none of these people had back pain.

Even in their 20s, about 1 in 3 had disc degeneration, and about 3 in 10 had a disc protrusion. By their 60s, almost 9 in 10 had disc degeneration and half had facet joint degeneration. In their 80s, it was rarer *not* to have disc degeneration.

In other words, the older you get, the rarer it becomes to hear “your lower-back MRI is normal.”

What this means: The disc degeneration or bulging on your lower-back MRI is something that shows up, quite often, in people your age who have no back pain at all. That alone is no reason to conclude that your back is broken.

The same thing happens in knees and shoulders

This isn’t only about the lower back.

Knees

A systematic review published in a sports medicine journal in 2019 looked at MRI findings in adults with no knee pain and no history of knee injury [2]. The research team, from Australia and Norway, pooled 63 studies covering 5,397 knees.

In knees with no pain and no injury, they found:

• Cartilage defects (worn or damaged cartilage): 24% overall — 11% in people under 40, and 43% in people 40 and older
• Meniscal tears: 10% overall — 4% under 40, and 19% at 40 and older

After 40, about 2 in 5 pain-free knees had cartilage defects, and about 1 in 5 had a meniscal tear. These are findings often given as “the cause of your knee pain.”

Shoulders

For shoulders, there’s data from Japan. In 2013, a team from Tohoku University and Akita University reported on a health screening of the residents of one village [3]. They ran an ultrasound on both shoulders of all 664 residents who took part, looking for tears in the rotator cuff (the tendons of the muscles that move the shoulder).

Of the 664 people, 147 (22.1%) had a full-thickness rotator cuff tear. By age:

• 20s to 40s: 0%
• 50s: 10.7%
• 60s: 15.2%
• 70s: 26.5%
• 80s: 36.6%

And of these tears, only 34.7% caused symptoms. The other 65.3% had none. Among people 60 and older, two out of three people with a tear had no pain and no trouble moving their shoulder.

When people hear “your rotator cuff is torn,” many picture a snapped rope — something that can never be undone. But in reality, more people with a tear are living normal lives than not. That’s what this data from ordinary residents in Japan shows.

What this means: Scan an aging body — lower back, knee or shoulder — and you will quite often find an “abnormality.” Much of the time, it’s a natural change that comes with age, like gray hair or wrinkles.

Why can you have an “abnormality” and no pain?

So why do some people have no pain even with a protruding disc, a torn meniscus or a torn rotator cuff?

There are several likely reasons.

Reason 1: Tissue changes happen slowly

The body reacts very differently to a sudden change and to one that builds up over years.

For example, when a young person tears a meniscus suddenly in sports, the knee swells and hurts. But when someone in their 50s has a meniscus that wears down little by little over ten years, the body adjusts — the surrounding muscles and the way they move adapt to the change. On the scan, both are called a “meniscal tear.” To the body, they mean very different things.

Reason 2: Pain is not a damage sensor

This may be the most important point.

We tend to think of pain as an alarm that tells us something in the body is broken — and that the bigger the damage, the stronger the pain.

But pain research has shown that pain is much more complex. It isn’t decided only by signals from the tissues. It’s shaped by many things together: how the brain interprets those signals, how anxious the person is, whether they’re sleeping enough, how stressful work is, and more.

So if the brain judges a tissue change as “not dangerous,” pain is less likely. And even without much change in the tissues, strong anxiety or tension can make pain feel worse.

You hear “you have a herniated disc,” you get anxious, you stop moving, your muscles stiffen, and pain comes more easily. In my clinic, I see this vicious cycle all the time. Sometimes the way a person takes in the finding affects their pain more than the finding itself.

Reason 3: “Abnormal” is often measured against a young, healthy body

What counts as “normal” on an MRI is often based on young, healthy bodies. But a back in its 60s is not going to look like a back in its 20s.

If 88% of people in their 60s without back pain have disc degeneration, then that is “normal” for people in their 60s. To me, calling it “abnormal” is a bit like calling gray hair in a 60-year-old a “hair abnormality.”

What this means: It’s safer to treat the “abnormality” on your scan and the “pain” you feel as two separate things. You’re less likely to draw the wrong conclusion.

So are scans useless? No

At this point, you may be thinking, “Then is there any point to getting tested?” There is. I want to be careful here.

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First, another review by the same research team compared people with and without back pain. It found that people with back pain were more likely to have findings like disc degeneration and protrusion than people without [4].

The difference was especially clear in people aged 50 and younger.

So scan findings and back pain are not completely unrelated. There is a link. But you can’t say “you have a finding, so that’s why it hurts,” and you can’t say “there’s no finding, so it can’t hurt.” The link is much weaker than most people think.

Scans also have another very important job: ruling out conditions that must not be missed.

Most back pain is not life-threatening, and it tends to settle over time. But very occasionally, something that needs to be found and treated early is hiding behind it — a fracture, an infection, a tumor, severe pressure on a nerve.

When one of these is suspected, a scan is essential.

When doctors decide whether to order a scan, they look closely for these “do-not-miss” warning signs. Put the other way around: research has shown that when those signs are absent, scanning early in an episode of back pain doesn’t change how things turn out very much.

A 2009 meta-analysis in The Lancet pooled trials in which people with back pain and no warning signs were split into two groups: “scan right away” and “start without a scan and see how it goes.” There was no difference in improvement in pain or function [5].

What this means: If you think of a scan less as “finding the cause of your pain” and more as “making sure there’s nothing serious that must not be missed,” I think you’ll be able to take your results more calmly.

Can getting scanned early actually slow recovery?

Let me go one step further.

Many people feel that getting scanned early is the safer choice.

But research offers a slightly different view.

A randomized controlled trial published in JAMA in 2003 split people with low back pain into two groups — “MRI right away” and “X-ray only at first” — and followed them for one year [6].

There was no difference between the groups in improvement in pain or function. But the MRI group tended to have a higher rate of surgery afterward.

Why would that happen?

One explanation is that once an MRI shows an “abnormality,” it tends to be treated as a target for treatment — whether or not it’s actually causing the symptoms.

Another is how the patient takes it in.

When you’re shown a scan and told “this is where it’s damaged,” your fear of moving grows, you become less active, and recovery slows. This kind of mechanism is studied as the “nocebo effect” — the opposite of the placebo effect, where negative information actually makes symptoms worse.

I want to be honest about one thing here:

These studies were about back pain without warning signs. They do not mean that every case of back pain should have its scan delayed. Whether to scan is always a decision for the doctor who examines you.

What I want to get across is that “the scan found something” is not always bad news. It’s worth checking once how common that finding is in pain-free people your age.

What this means: When you get your results, try asking your doctor: “How common is this finding in people my age? Is it a typical change?” That alone can change how the numbers look to you.

Three ways to read your numbers

Let’s turn everything so far into something you can use when you get your results.

Lens 1: Compare with healthy people your own age

Whether something is “abnormal” should be judged against people your age without symptoms — not against a young, healthy body. In your 60s, disc degeneration is a change shared by almost 9 in 10 people.

Lens 2: Check it against your symptoms and what you can do

What you can and can’t do matters more than how the scan looks.

• Do you have pain? When does it come on?
• Can you walk? Climb stairs? Squat down?
• Is it getting in the way of work or housework?
• Are you sleeping at night?

If you have a big finding on your scan but these are all fine, your body is adapting well. On the other hand, if the finding is mild but your daily life is affected, that’s what needs attention first.

Lens 3: Look at the trend, not one result

A single scan is a snapshot of one moment. What matters is how things change over time. Are your symptoms getting better, worse, or staying the same? That trend tells you far more than one image.

What this means: A test result is not a verdict. It’s one piece of information to weigh. It only becomes meaningful alongside your symptoms, your function, and how things change over time. (For the function side, it’s worth working through it with a physical therapist.)

What I’ve seen as a physical therapist

Let me share a little of my own clinical experience.

In rehabilitation, I meet people whose scans and symptoms don’t match almost every day.

Someone with a large herniation on their MRI who has almost no back pain, only numbness in the leg. Someone with only mild degeneration on their scan who comes in barely able to move from pain. Someone with a meniscal tear who climbs stairs without a problem. Someone with a full rotator cuff tear who has almost no trouble in daily life.

Seeing these people, I’ve become convinced of one thing: a scan shows structure, but it doesn’t show movement.

Much of the pain and stiffness I see has less to do with the structure itself and more to do with how that structure is being used.

Stiff hips that concentrate load on the lower back. Glute muscles that don’t switch on, so the knee drops inward. A shoulder blade that doesn’t move, so the rotator cuff takes extra strain.

These movement habits don’t show up on an MRI. But when they change, symptoms often change too — even though the scan stays the same.

So whenever I talk to a patient about their scan, I always add something like this:

“That finding is definitely there. But it’s a very common change at your age, so we can’t say it’s the root of everything. Let’s look at how you move together.”

Getting stuck on a scan finding and becoming afraid to move can slow recovery more than the finding itself. After more than ten years in this work, that’s one of the things I feel most strongly.

Signs that still mean you should see a doctor

Finally, here’s something I must say.

This article has been about not being overly afraid of scan findings. That does not mean it’s fine to ignore your symptoms.

If you have any of the following signs, please see a doctor soon — whatever your scan shows.

• Pain that started after a clear injury, such as a fall or an accident
• Pain that doesn’t ease with rest and continues at night
• Pain with a fever
• Arms or legs getting weaker, or numbness that’s spreading
• Changes in how you sense or control your bladder or bowels
• Unexplained weight loss along with the pain
• New pain in someone who has been treated for cancer
• No sign of improvement at all after several weeks

These are typical signs that make doctors suspect a “do-not-miss” condition. If any of them apply to you, don’t judge it on your own — please get seen.

And if you’re already under a doctor’s care with a treatment plan, please don’t change that plan because of this article. If you have questions, asking your own doctor directly is the surest way.

Treat this article as background reading. Your doctor’s advice comes first.

Summary

Here’s what we covered:

• In people with no back pain, more than 3 in 10 in their 20s and almost 9 in 10 in their 60s show disc degeneration on scans [1].
• Knees and shoulders are the same: 4 in 10 pain-free knees over 40 have cartilage defects, and in a Japanese village, two-thirds of rotator cuff tears had no symptoms [2, 3].
• Pain isn’t decided by tissue damage alone. How the brain interprets signals, anxiety, and daily life all play a part.
• Still, scan findings and symptoms aren’t unrelated, and scans have a vital role in ruling out conditions that must not be missed [4, 5].
• For back pain without warning signs, early scanning hasn’t been shown to improve outcomes [6].
• Read your results together with three things: people your own age, your symptoms and function, and the trend over time.
• If you have warning signs, see a doctor — whatever your scan shows.

Test numbers aren’t there to scare you. They’re there to help you understand your own body. When you see the word “abnormal,” pause for a moment and ask yourself: “How common is this at my age?”

That alone can change your relationship with your body a little.

I hope this article is useful to you.

References

1. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811–816. DOI: 10.3174/ajnr.A4173, PMID: 25430861
2. Culvenor AG, Øiestad BE, Hart HF, et al. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268–1278. DOI: 10.1136/bjsports-2018–099257, PMID: 29886437
3. Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013;10(1):8–12. DOI: 10.1016/j.jor.2013.01.008, PMID: 24403741
4. Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36(12):2394–2399. DOI: 10.3174/ajnr.A4498
5. Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373(9662):463–472. DOI: 10.1016/S0140–6736(09)60172–0
6. Jarvik JG, Hollingworth W, Martin B, et al. Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA. 2003;289(21):2810–2818. DOI: 10.1001/jama.289.21.2810

Disclaimer

• This article is general health information. It is not medical care or a medical diagnosis, and it does not replace either.
• If you have symptoms or are currently being treated, please talk to a medical professional.

I’m Kudochin, a physical therapist in Japan. I write about knee, back and joint pain from what I see in the clinic — always with the research behind it. If that’s useful to you, follow me for new articles each week.