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MRI Doesn't Tell the Whole Story

Aret Aboulian
Aret AboulianChiropractor
March 24, 20265 min read

A normal-looking scan doesn't rule out nerve pain, and a scary-looking one doesn't guarantee it. Here's what imaging can and can't tell you.

What an MRI Is Actually Good At

MRI is an excellent tool for what it's designed to do. But for full nerve pain diagnosis, structural imaging is only one part of the picture.'s designed to do: showing structure. Disc height, alignment, obvious compression, tumours, fractures, and other structural pathology are all things imaging can pick up reliably, and there are absolutely cases where a scan is essential, particularly when there are red flag symptoms like progressive weakness, loss of bladder or bowel control, or unexplained weight loss alongside pain.

For those situations, imaging isn't optional. It's part of ruling out anything genuinely serious before we move forward with conservative care.

What It Misses

Why sciatica is a symptom description, not a diagnosis, what an MRI can't't directly show is function, how a nerve is actually behaving when you move, how sensitised your nervous system currently is, or how much a particular structural finding is actually contributing to your symptoms versus simply being present. Two spines can look almost identical on a scan and produce two completely different clinical pictures.

This is why patients are sometimes told their scan is normal despite real symptoms, the research on asymptomatic disc findings confirms how common this gap is. 'your scan is normal' despite very real, very limiting symptoms, the mechanism may be more about nerve irritation, movement dysfunction, or sensitisation than about a structural abnormality large enough for imaging to flag.

Why Two People, Same Scan, Feel Completely Different

Pain is generated and modulated by the nervous system, which is why our neurological and orthopaedic assessment process looks beyond the scan., not purely by tissue damage. Someone with a relatively minor structural finding can have significant nerve sensitisation and disproportionate symptoms, while someone with a more significant structural finding can have very few symptoms at all. Neither scenario is unusual, and neither is a sign anything is 'wrong' with the patient, it's simply how pain physiology works.

A More Complete Picture

Good assessment combines imaging (where clinically warranted) with a hands-on neurological and orthopedic examination, testing how your body actually responds to specific movements, positions, and provocation tests. That combination tells us far more than a scan alone ever could, and it's the basis for a treatment plan that addresses what's actually happening, not just what shows up on a report.

For educational purposes only. Does not supersede advice from your GP or specialist.

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