By Dr. Shivam Chopra

Dr. Shivam Chopra is a distinguished Orthopedic and Sports Physiotherapist with over seven years of clinical experience in the assessment, treatment and rehabilitation of musculoskeletal injuries and disorders. Having worked extensively with elite athletes as well as individuals from all walks of life, he is committed to making evidence-based physiotherapy and movement science practical and accessible. Through his column, ‘Movement Matters’, Dr. Chopra seeks to dispel common misconceptions, promote injury prevention, encourage active living and empower readers to make informed choices for lifelong musculoskeletal health. To connect with Dr. Shivam Chopra: Call: +919930831317 / E: shivamchopra@projectmovement.in

Understanding Why Scans Don’t Always Explain Pain And Why The Right Assessment Matters.

Jehangir, a 42-year-old software engineer, walked into my clinic clutching his MRI report. Before I could even ask where it hurt, he pointed to the words: ‘Disc Bulge’ and fearfully asked, “Will I ever be normal again?”

It wasn’t just the pain that troubled him, but the fear that his spine was permanently damaged and that every movement would worsen his condition. Sadly, Jehangir’s story is far from unique. Over the years, I’ve met countless patients who believed that a few words on an MRI report had already determined the course of their future.

But here’s what you should know… An MRI can show changes inside your body, but those changes don’t always explain why you’re in pain. That’s one of the biggest misconceptions about pain. Most of us naturally believe that the more pain we feel, the more damage there must be. That is not always the case. Understanding the difference can reduce unnecessary fear and help you make better decisions about your recovery.

X-RAYS & MRI Scans Do Not Always Explain Your Pain

There’s no doubt that modern imaging has transformed healthcare. X-rays, CT scans and MRIs help us diagnose fractures, ligament injuries, muscle tears and many other conditions with remarkable accuracy. They’re incredibly valuable tools, but they’re only a part of the puzzle. While a scan shows us what your body looks like on the inside, it cannot measure the intensity of your pain. Studies show that many people without symptoms have disc bulges, arthritis or joint wear. In many cases, these findings are simply a normal part of ageing, much like wrinkles or grey hair.

If you’ve had an X-ray or MRI, look at the final line of the report, which reads, “Please correlate the findings clinically.” That simple statement carries an important message: scans should never be interpreted in isolation. Your symptoms, medical history and physical examination are equally vital. In the end, your doctor or physiotherapist treats the person, not the scan.

The reverse is equally true! Some individuals experience severe pain despite completely normal scan results. How is that possible? Pain is far more complex than tissue damage alone. It is shaped by the nervous system, previous injuries, stress, sleep quality, emotions and overall health, all of which influence how intensely pain is perceived.

Acute Pain Vs. Chronic Pain

Not all pain behaves in the same way. Acute pain usually follows a recent injury, surgery or illness. It’s your body’s natural alarm system, encouraging you to protect an injured area while it heals. For eg., an ankle sprain, a muscle strain or a fracture – as healing takes place, the pain usually settles.

Chronic pain is different. When pain lasts for more than three months, the injured tissues may have healed, but the body’s pain alarm remains switched on for longer than necessary. Think of it like a smoke alarm that keeps ringing long after the fire has been extinguished. While it was initially protecting you, it has now become over-sensitive. Chronic pain behaves in much the same way. The pain is real, but it does not necessarily mean ongoing damage is occurring within the body.

When In Pain…

First off – DO NOT PANIC. For most injuries like a sprained ankle or muscle strain, follow the ‘PEACE & LOVE’ approach:

PEACE:

P – Protect: Avoid activities that significantly increase your pain.

E- Elevate: Raise the injured area whenever possible.

A- Avoid: Avoid anti-inflammatory medication unless advised by your healthcare professional.

C- Compress: Use appropriate compression to help manage swelling.

E- Educate: Understand your injury and focus on active recovery.

LOVE

L – Load: Gradually return to movement as your pain allows.

O – Optimism: A positive mindset can improve confidence and support recovery.

V – Vascularity: Gentle activities such as walking or cycling improve blood flow and support healing.

E – Exercise: Progressive exercise helps restore strength, movement and confidence.

Consulting A Specialist Matters

Scans don’t tell stories. People do! While an MRI or X-ray reveals the condition of your tissues, only a comprehensive clinical assessment can determine what those findings truly mean.

A skilled physiotherapist looks beyond the report, listens to your history, understands how the pain began, assesses your movement, strength, flexibility and daily function, while identifying any warning signs that require medical attention. This is why two people with identical scan results often need entirely different treatment plans. The right diagnosis leads to the right care, helping you understand your pain, regain confidence and return to an active, fulfilling life.

 Until next time… Keep moving – Trust your body, Trust the process. Because Movement Matters.