For about ten years, I told people I had an L4/5 instability. That was my diagnosis, and at some point it became my identity. I'd walk into PT courses and introduce myself that way: Clay Jones, L4/5 instability, can't do this, this, or this.
Then I came across a research study early in my career that changed how I practice completely.
If you've been told your back pain is caused by a disc bulge, degenerative disc disease, or a pinched nerve, that finding alone almost certainly isn't the full story. Researchers have scanned thousands of people with zero back pain and found the exact same "abnormal" findings showing up at strikingly high rates. The image and the symptom often don't line up the way most people assume.
The study I point to most often is a 2015 systematic review published in the American Journal of Neuroradiology, which pooled imaging results from over three thousand people with no back pain at all, across every age group from twenty to eighty.
The findings are striking. Disc degeneration showed up in 37 percent of pain-free twenty-year-olds, climbing to 96 percent by age eighty. Disc bulges followed a similar climb, from 30 percent at twenty to 84 percent at eighty. Even disc protrusions, where the bulge presses against a nerve, were present in 29 percent of pain-free twenty-year-olds and 43 percent of pain-free eighty-year-olds. These are people who reported zero pain. Their scans tell a different story.
So many of my patients had been told by a well-meaning physician that they had the spine of an eighty-year-old, or that they needed to stop bending over, stop lifting, stop running. However, if you imaged every back walking around with no complaints, a large share of those scans would show something that could be blamed for pain. Sometimes that blame is accurate. In my experience, more often it isn't.
A scary-sounding MRI report does real damage even when the finding itself is harmless, because of what it does to how a person moves afterward. I was scared for about a decade of bending backwards because I believed my "instability" meant I'd hurt myself if I did. That fear isn't only psychological. It raises cortisol and stress hormones, which makes pain fibers more sensitive. The brain's fear center and pain center sit right next to each other, and they feed each other.
That's the trap. The report says "instability" or "degeneration," the patient hears "fragile," and the fragility itself, not the disc, becomes the thing driving months or years of guarded movement. The thing I try to give people most is permission to have pain without assuming pain equals damage. Those are not the same thing, even though it feels like they should be.
When someone comes in with an MRI report describing a bulge, degeneration, or a pinched nerve, I take that seriously and then run a deeper, hands-on evaluation rather than treating the report as the final word. A full hour, one-on-one, watching how someone actually moves, checking reflexes, sensation, strength, and joint mobility directly.
What I'm checking for is whether the report actually matches what's happening clinically. A disc finding that lines up with where someone's symptoms are, how they move, and what makes things better or worse carries real weight. A disc finding that doesn't match any of that is much more likely to be one of the age-related changes the research describes, not the cause of the pain.
From there, the plan usually centers on rebuilding strength and confidence in the movements someone has been avoiding, not protecting the area indefinitely based on what a report said.
Not necessarily, and often not at all. Disc bulges show up in a large share of people with zero pain at every age, so a bulge on a scan doesn't automatically explain the symptoms someone is feeling. The image needs to match the clinical picture, not stand in for it.
For most acute, recent-onset back pain, going straight to imaging tends to lead down a more complicated road, including a higher likelihood of injections or surgery for findings that may not be the actual source of pain. The clear exception is progressive neurological symptoms, worsening numbness, or new and increasing weakness, which is a legitimate reason to get evaluated and likely imaged.
Degenerative changes are common findings that increase with age in people with and without pain. They describe normal changes over time, not a prediction that your back is destined to get worse or that you need to stop being active.
Start with a real hands-on assessment that checks your actual function, not just the report. From there, an active plan paired with understanding which movements genuinely help versus which ones to modify is what actually changes the trajectory.
Curious what your own scan results actually mean for you? [Book an evaluation with 901PT.]
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