We are overdiagnosing and undertreating.
And honestly, I get it.
Not knowing what’s going on inside your body can feel incredibly uncomfortable. Your brain starts filling in the blanks. You begin thinking, overthinking, catastrophizing. Fear creeps in. You become careful. Protective. Hyperaware.
(As an overthinker myself: trust me, I know the drill.)
I deal with these thoughts almost daily in practice. And I’ve experienced them myself, too.
Because when something hurts, you want answers.
You want certainty.
So your doctor sends you for an MRI. An X-ray. A CT scan. Maybe multiple.
And to be clear: imaging absolutely has its place. Sometimes it’s necessary and incredibly important.
But we also have to acknowledge something uncomfortable:
Imaging is just one diagnostic tool.
And it’s far from perfect.
Because no scan in the world can actually show pain.
Pain is an experience. A feeling. Not a photograph.
The idea behind imaging is usually straightforward:
“If we find the root cause, we can fix the problem.”
Sounds logical, right?
The problem is: the human body isn’t nearly as simple as we wish it was.
Pain does not automatically mean something is damaged, broken, or dangerous.
Pain is an alarm system.
And just because your alarm system goes off doesn’t automatically mean somebody broke into the house.
Sometimes somebody only touched the door.
Sometimes the wind triggered the sensor.
And sometimes the alarm system itself has become overly sensitive.
I recently had a patient who insisted on getting imaging done.
The interesting part?
She was already improving.
Her pain was getting better. Her function was improving. And I told her honestly that the scan probably wouldn’t change my treatment plan at all.
But she still wanted to know.
And that’s okay.
The important part was that we talked about it beforehand. We talked about what imaging can show, what it can’t show, and how common “abnormalities” can be completely normal findings.
So when the results came back, she stayed calm.
Many people don’t have that luxury.
A colleague of mine didn’t.
The moment she received her imaging results, everything changed emotionally.
Fear crept in immediately.
And the fascinating part?
She’s a psychotherapist. A highly reflective person. She intellectually understood that imaging findings don’t automatically equal danger.
And yet she still said:
“I know I shouldn’t be afraid… but now that I know my diagnosis, I am.”
Her confidence dropped almost overnight.
Her behavior changed.
Her perception changed.
That’s how powerful information can be — especially when it’s framed without context.
And this is where healthcare sometimes accidentally creates harm.
Because many findings on imaging are incredibly normal.
Disc degeneration.
Disc bulges.
Arthritic changes.
Rotator cuff tears.
Meniscus changes.
A lot of these findings increase simply because you’ve successfully managed not to die for a couple of decades.
Research shows this repeatedly.
As Medical Imaging research by Nakashima et al. (2015) showed:
Disc bulging was frequently observed in asymptomatic subjects, even including those in their 20s.
In other words:
People can have “terrible-looking” scans and feel completely fine.
And this isn’t just one isolated study.
As this table from the Brinjikji et al. (2015) study shows, many so-called “abnormal” findings become increasingly common with age — even in people without any pain at all.
Which means:
Aging, degeneration, disc bulges, and structural changes are often part of being a human being with a functioning spine — not automatically proof that your body is damaged or doomed.
And people can have severe pain with scans that barely show anything remarkable.
Because pain is rarely explained by just one thing.
That’s the frustrating answer. But also the honest one.
Pain is multifactorial.
Sleep.
Stress.
Fear.
Load.
Recovery.
Movement.
Beliefs.
Previous experiences.
Lifestyle.
Health anxiety.
Physical conditioning.
Sometimes tissue sensitivity matters a lot. Sometimes it barely matters at all.
The body is less like a broken machine and more like an ecosystem.
That’s why I often read the diagnosis, keep it in mind, and then focus on treating the person in front of me — not just the scan.
Because in many cases, my overall treatment approach barely changes.
We calm things down.
Build confidence.
Improve capacity.
Increase tolerance.
Reduce fear.
Gradually expose the body to movement again.
In other words:
We stop chasing perfect-looking scans and start helping humans function better again.
And honestly?
That approach tends to work surprisingly well.
🧪 Let’s Experiment
Sometimes the most dangerous thing about pain isn’t the pain itself —
it’s the story we attach to it.
A scan can be useful. But it can also quietly become an identity.
“Damaged.”
“Fragile.”
“Broken.”
“Worn out.”
And once people start believing that story, they often stop trusting their body long before their body actually stopped being capable.
🎯 Try This:
The next time you catch yourself thinking:
- “I have bad discs.”
- “My knees are destroyed.”
- “My shoulder is damaged.”
- “My posture is terrible.”
Pause for a moment and ask yourself:
- “Is this objectively true?”
- “Or is this just the interpretation I attached to the information?”
Because there’s a big difference between:
“I have pain.”
and:
“My body is broken.”
🧠 Final Thought:
Many people don’t just become limited by pain. They become limited by what they believe pain means.
Keep it simple, stay curious, and keep learning—you’ve got this.
Take care,
Carina 🦊