What happens when your pain doesn’t show on x-ray or MRI?

Here is one of the top three reasons people wind up in my clinic:

"I'm hurt and I've been to the doctor and nothing shows up on an x-ray or MRI but I can't do what I want to. No one can find anything wrong with me."

Having a diagnosis or an injury that does not show up on x-ray or MRI is more common in my office than having a diagnosis that does show up on a scan.  While people heavily rely on x-rays, MRIs or CT Scans, the truth is that most everyday aches and pains do not show up on any imaging devices or anything at all.

Why is this?  Most problems that cause every day aches and pains are muscle related.  And while muscle does show up on some scans, it will only show a problem if there is a tear or A LOT of inflammation.  For most people that have pain, it is caused by muscle imbalances, not anything that can be surgically repaired or can be seen on imaging.

Another popular phrase I hear:

"But my scans showed arthritis so that must be the cause of the pain and there is nothing that can be done about it."  

Outside of replacing your joint, there is nothing that can be done to 'cure' arthritis.  But what always perplexes is me is that one joint always seems to have worse arthritis or more pain than the other one.  To me that is a big red flag.  Take your knees for example, how does one knee get arthritis faster or more severe than the other.  Is the one leg walking less than the other leg?  Does the one leg do more standing than the other leg?  No, for the most part your legs do the same amount of activity.  So why do you have breakdown and pain and arthritis in one leg and not the other?  Imbalances, most often in the muscle,are the cause.

Let's continue with the knee example.  Say there is pain in the knee.  You have been to the doctor and had the tests and the scans and it has come back as arthritis or nothing showed up.  But your knee gets worse when you go up and down the stairs or stand for long periods of time but then if you lay down the pain goes away.  So is your arthritis only there part of the time?  Why does pain only happen at certain times and not others when doing the same activity?  Again, muscle imbalances.

So what is a muscle imbalance?  A muscle imbalance could be a number of things, it could be a weak muscle that is giving in and letting the stronger muscles work overtime for it.  It could be a muscle that has a lot of knots, and therefore, is not able to relax and stretch out as much as needed in order to function correctly.

Imagine a piece of string from your hip to your knee.  Take that string and tie a bunch of knots in it.  Watch it get shorter.  Now if that string was connected to something on the other side, it would start to pull on that side.  This is how knots in the muscle work. Those in one muscle can affect all the rest of the muscles and begin to cause pain.

The bottom line is that not all pain is able to be detected on an x-ray or MRI.  That does not mean that there is nothing there that needs to be treated or diagnosed.  In fact, it means that it is possibly a precursor to something going really wrong and then eventually needing surgery because it eventually winds up torn.  Don't ignore pain because it can't be diagnosed by a fancy scan.  It may take a deeper look into how the muscles are functioning together before all the answers come into place.