You finally got the MRI. The radiologist's report comes back full of clinical language — disc bulges, foraminal narrowing, facet arthropathy — and suddenly you feel like you have answers. But then your doctor shrugs and says, "These findings are common. They may or may not be causing your pain."
You're confused, possibly frustrated, and still hurting.
You're not alone — and your confusion is actually backed by decades of medical research.
The Uncomfortable Truth About Back Pain Imaging
MRI technology is genuinely remarkable. It gives clinicians a detailed, radiation-free window into the soft tissues of your spine — discs, nerves, and ligaments. But here's what most patients are never told: an MRI captures anatomy, not experience.
It shows what your spine looks like at rest, in a tube, on a particular Tuesday. It cannot show how your spine moves, which positions provoke your pain, which muscles have stopped firing correctly, or how your nervous system is interpreting signals from your body.
The result is a well-documented phenomenon in spine medicine sometimes called the "imaging-pain disconnect" — a consistent gap between what appears on a scan and what a patient actually feels.
"Imaging tells you what your spine looks like. A thorough clinical examination tells you how it's working — and those two things are often very different stories."
— Dr. Matthew T. Jacobs, DC, The Disc Doctor
- •96% of pain-free adults over 80 show disc degeneration on MRI (AJNR, 2015)
- •37% of asymptomatic adults in their 20s already have disc bulges on imaging (AJNR, 2015)
- •~50% of people with significant stenosis on MRI report little to no pain (Spine Journal, 2025 systematic review)
These numbers aren't meant to dismiss your findings or tell you imaging is useless. They exist to reframe it — as one piece of a much larger clinical puzzle.
What Your MRI Cannot Show
1. Joint Dysfunction and Segmental Restriction
Spinal joints that are hypomobile — stuck in a restricted range of motion — are one of the most common drivers of low back and neck pain. A chiropractor can detect these restrictions through hands-on palpation and motion assessment. An MRI, taken while you're lying still, simply cannot capture them.
2. Muscle Inhibition and Compensatory Patterns
When one area of your spine is injured or irritated, the surrounding muscles often "shut down" in a protective pattern. Neighboring muscles then compensate, getting overloaded and eventually painful themselves. This is called a motor control deficit — and no scan will find it. A qualified chiropractor evaluating your movement will.
3. Nerve Sensitivity vs. Nerve Compression
Radiating pain down the leg or arm doesn't automatically mean a nerve is being physically compressed by a disc. Nerves can become sensitized — chemically irritated and hypersensitive — without any structural impingement. An MRI may look completely normal while your nervous system is producing significant pain. This is one of the most commonly missed pieces of the back pain puzzle.
4. Your Functional Baseline
Two people can have identical MRI findings with completely different pain experiences. What predicts your outcomes isn't just anatomy — it's how your spine is actually functioning: range of motion, load tolerance, and how your body distributes force through movement. That requires a clinical examination, not an imaging report.
5. The Source vs. The Generator
A disc bulge at L4–L5 may be present on your MRI — but that doesn't mean it's generating your pain. Your pain might actually be coming from a facet joint at L3–L4, sacroiliac joint inflammation, a tight piriformis irritating your sciatic nerve, or a trigger point in your quadratus lumborum. Chasing the scan instead of the symptom pattern leads to missed diagnoses and ineffective treatment.
MRI vs. Chiropractic Clinical Evaluation: What Each Reveals
The Complete Picture: How We Approach Diagnosis at The Disc Doctor
At The Disc Doctor in Murfreesboro, we treat your imaging as a chapter in your story — not the whole book. Dr. Matthew T. Jacobs, DC takes an integrative, evidence-based approach that begins with understanding you: your history, your symptom behavior, your activity level, and your goals.
Your clinical examination includes:
- •Assessment of spinal mobility and range of motion
- •Orthopedic and neurological testing to identify the true pain generator
- •Muscle strength, activation, and coordination evaluation
- •Postural and movement pattern analysis
- •Careful correlation of any imaging findings with what your body is actually doing
This process is what transforms a stack of imaging reports into an actual plan — one targeted to your specific presentation rather than a generic protocol built around a scan result.
"We've seen patients told they need surgery based on their MRI who were back to full activity in six weeks with conservative care. We've also seen patients with near-normal imaging who needed far more complex management. The scan is not the patient."
— Dr. Matthew T. Jacobs, DC, The Disc Doctor
When Is Imaging Actually Important?
This isn't an argument against MRI — it's an argument for using it intelligently. Imaging becomes critically important when:
- •There are neurological red flags such as progressive weakness, bowel or bladder dysfunction, or signs of myelopathy
- •Conservative care has not produced improvement after an appropriate trial period
- •Fracture, tumor, or infection is suspected
- •Surgical consultation may be warranted and imaging is needed to guide decision-making
Outside of these scenarios, rushing to imaging early in a back pain episode is not only unnecessary — research suggests it can actually worsen outcomes by focusing attention on structural "abnormalities" that aren't clinically meaningful, increasing anxiety and fear-avoidance behavior.
Frequently Asked Questions
Can an MRI miss the actual cause of my back pain?
Yes — and this is well established in the medical literature. MRI findings like disc bulges, herniations, and stenosis are present in a large percentage of completely pain-free adults. Conversely, patients with debilitating pain often have imaging that looks relatively normal. An MRI captures anatomy; it doesn't capture how your spine is functioning or which structures are actively generating your pain.
What does a chiropractic exam find that an MRI doesn't?
A chiropractic evaluation assesses joint mobility, segmental restriction, muscle strength and activation deficits, nerve tension, postural compensation, and how specific movements provoke or relieve your symptoms. These are functional findings that no imaging technology can detect — and they frequently reveal the true pain generator.
Does a disc bulge on MRI always mean I need surgery?
No. The majority of adults have disc bulges visible on MRI and experience no symptoms whatsoever. A disc bulge only becomes clinically significant when it correlates with your specific symptoms, provocative testing, and neurological findings. Most disc-related pain responds very well to conservative chiropractic care, and surgery is appropriate only in a minority of cases.
Should I get an MRI before seeing a chiropractor?
For most cases of acute or subacute back pain without red flags, a clinical evaluation is the appropriate starting point. If you already have imaging, Dr. Jacobs will review and incorporate it into your assessment. If imaging is clinically indicated after your examination, he will advise accordingly.
Where can I get a complete back pain evaluation in Murfreesboro, TN?
The Disc Doctor is located at 272 Heritage Park Drive, Murfreesboro, TN. Call (615) 617-5550 to schedule.
Office hours: Monday, Wednesday, Thursday 10am–1pm & 3–6pm · Tuesday 3–6pm · Friday 10am–1pm.
