Your MRI Looks Normal But You're Still in Pain. Here's Why That Makes Complete Sense.

On the gap between what a scan can see and what the nervous system is actually doing.

You have the report. You've read it, or had it explained to you, or both.

Maybe you felt a brief flicker of hope before the appointment. Maybe you told yourself: at least now I'll know. At least there will be something to point to, something that explains the months of waking up braced, the days that have quietly reorganised themselves around the pain.

And then the result came back. And it said, more or less: nothing significant. Or it said something was there, something with a name, but nothing that should be causing this much trouble. You were told you were fine.

You are not fine. And you are still in pain.

There is a particular kind of loneliness in that moment. Not just disappointment. Something closer to erasure. The system looked, and it either found nothing, or found something it considers unremarkable, and either way you walked out of the appointment still carrying what you walked in with. The pain, and now also the silence around it.

If you have been in that place, I want to say something clearly before anything else.

The pain is real. Whatever the scan says or doesn't say, whatever the report found or failed to find, the pain you are feeling is not imaginary, not exaggerated, and not a sign that something is wrong with you as a person. It is a real, physical experience. That is not in question.

What is in question is the story we have been taught about what pain means, and what a scan can and cannot tell us about why it is happening.

What scans actually measure, and what they don't

Imaging is a remarkable tool. It can identify fractures, tumours, infections, significant structural compromise. For those purposes, it is invaluable.

What it cannot do is explain pain.

This is not a fringe view. A landmark systematic review published in the American Journal of Neuroradiology in 2015 examined imaging findings in people with no back pain at all, people who were completely symptom-free. The findings were striking. Disc degeneration was present in 37% of 20-year-olds and in 96% of 80-year-olds. Disc bulges appeared in more than half of people in their 40s. Disc protrusions were common across all age groups (Brinjikji et al., 2015).

Similar findings have been replicated for the cervical spine. Nakashima et al. (2015) found disc bulging in 87.6% of asymptomatic subjects, including 73–78% of people in their 20s, with no pain at all.

These are people with no pain. The findings were incidental: present, but causing nothing.

This doesn't mean your findings aren't real. It means that the presence of a structural finding and the experience of pain are not the same thing. One does not reliably predict or explain the other.

Pain is not produced by tissue. It is produced by the brain, in response to signals from the nervous system, shaped by context, history, meaning, and threat perception. This is not a controversial position. It is the current scientific understanding of how pain works (Moseley & Butler, Explain Pain, 2013).

With that as the foundation, let's look at some of the specific ways the scan result may have landed, and why none of them mean what they seemed to mean.

"Degeneration." The word itself became the wound.

Some people receive their scan results and feel, not reassured, but quietly devastated, even when the radiologist considers the findings unremarkable.

The language of imaging reports was not designed with the reading patient in mind. Degeneration. Wear and tear. Narrowing. Deterioration. These are clinical descriptors, but they carry a narrative. A direction of travel. They suggest a body that is breaking down, ageing badly, losing ground.

One of my clients described reading the word "degeneration" and feeling, for the first time, that her body was something she could not trust. Not a home. A liability. She had been trying to make sense of years of pain, and now she had a word that seemed to explain it. Her body was deteriorating. Of course it hurt.

What nobody told her, and what the report did not say, was that disc degeneration is present in the majority of adults from middle age onward, and that most of those people are not in pain. The finding described an anatomical reality. It said nothing reliable about the origin of her experience.

Words carry meaning. When the words we are given to describe our bodies are words of decline, we carry that story in the nervous system, and the nervous system responds accordingly.

"But the pain is right there, where they found something."

This is one of the most understandable conclusions a person can draw, and one of the most difficult to gently loosen.

If you have pain in your lower back, and the scan shows a disc bulge at L4/L5, the proximity feels like proof. The finding and the symptom are in the same postcode. How could they not be connected?

The difficulty is that this reasoning, intuitive as it is, does not hold up when tested. The Brinjikji study cited above found these structural changes consistently in people who had no pain at all. If the finding reliably caused pain, those people would be in pain. They are not.

What we are observing, in many cases, is coincidence of location rather than causation. The finding is real. The pain is real. The assumption that one is producing the other is where the logic breaks down.

This is not a comfortable thing to hear. It can feel like being told that the map is wrong when you are standing right there, looking at the landscape. But sometimes the map and the landscape are genuinely different things, and understanding that difference is the beginning of a different kind of journey.

"Something must have changed after the accident."

For some people, the question is not about a scan finding in isolation. It is about a specific moment: a fall, a car accident, a sudden movement, a surgical procedure, after which the pain began and never fully left.

The temporal sequence feels like evidence. Before the event, no pain. After it, pain. What other explanation could there be?

Something did happen. The event was real. The body was genuinely affected. And in many cases, there may have been acute tissue damage that healed, and healed well, in the weeks or months that followed.

What sometimes persists is not the tissue damage, but something the nervous system learned in response to it.

At the moment of impact or injury, the nervous system activates a protective response. Pain, in that context, is appropriate and useful. It signals the need for care, rest, attention. But the nervous system can sometimes continue generating that signal long after the tissue has healed. It learned that this area is dangerous. It is still applying that lesson, conscientiously, to a situation that no longer requires it.

This is not dysfunction. It is the nervous system doing exactly what it was designed to do, and being, in a sense, too good at its job. Alan Gordon and Alon Ziv describe this process in detail in The Way Out (2021), and it is central to understanding why pain so often outlasts injury.

The event happened. The learning happened. The pain that followed both of those things is real. And the fact that it is still here does not mean the damage is still there.

I have worked with people who found this reframe almost physically relieving. Not because it made the pain disappear, but because it meant the body was not still broken. It meant the story was not finished in the way they had feared.

"The disc affects the hip, which affects the glute, which affects the knee..."

This is perhaps the most complex belief to hold gently, because it was usually not arrived at alone.

Over months or years of seeking help, many people with chronic pain have seen multiple practitioners: physiotherapists, osteopaths, chiropractors, sports therapists. Each one has offered observations. A slight pelvic tilt here. Underactive glutes there. A rotational compensation somewhere else. Taken individually, each observation may have been accurate and well-intentioned.

But over time, the person pieces these fragments together into a coherent structural narrative: my disc problem caused an imbalance, which caused a compensation, which is why the pain has now spread to my hip and knee.

The story feels medically plausible. It has texture and detail. It was built with the help of professionals.

The difficulty is that this kind of cascading structural explanation, while it sounds logical, is not well supported by the evidence for most cases of persistent pain. Chronic pain that moves, spreads, or changes location is actually more consistent with a sensitised nervous system than with a chain of structural failures (Moseley, 2007). The nervous system, once in a state of heightened alert, can generate pain signals across multiple areas: not because each area is damaged, but because the alarm system has become, in a sense, very loud.

This does not mean every practitioner you saw was wrong. It means the story that was handed to you, piece by piece, may have been incomplete: not in its individual parts, but in the conclusion it seemed to lead toward.

"If it's not physical, then something must be wrong with me."

This is where I want to sit for a moment, because I think it is where many people end up, and where the most harm can quietly be done.

When the scan shows nothing significant, or when a person begins to encounter the idea that their pain might have a nervous system origin rather than a structural one, there is a conclusion that the mind reaches almost immediately: if it's not in my body, it must be in my head.

And if it's in my head, it means I am weak. Anxious. Too sensitive. Unable to cope. The problem is not the disc or the nerve. The problem is me.

I want to be direct about this, because it matters.

Neuroplastic pain is not psychological in the way that phrase is commonly understood. It is not imagined. It is not a sign of emotional fragility or an inability to manage stress. It is not, in any meaningful sense, a character flaw.

It is what happens when a nervous system that has been under sustained threat begins to generate protective pain signals in excess of what the tissue situation requires. This is a biological process. It happens in bodies. It is not a reflection of who you are or how strong you are.

The fear-avoidance research (Vlaeyen & Linton, 2000) has documented for decades how entirely normal it is for a nervous system exposed to persistent pain to become hypervigilant: scanning for threat, amplifying signals, bracing. This is not weakness. It is adaptation. The nervous system is doing its job under difficult conditions.

NICE NG193, the NHS guideline on chronic primary pain, acknowledges explicitly that chronic pain often cannot be explained by tissue damage alone, and recommends approaches that address the psychological and social dimensions of pain alongside the physical. This is not a fringe position. It is current NHS guidance.

The shift from "my body is damaged" to "my nervous system is protecting me" is not a small one. But it is the shift that makes recovery possible in a way that no further scan can offer.

What this opens up

None of what I have described above means that your experience is simple, or that understanding this will make the pain disappear overnight.

It means that the framework you were handed, the one where pain equals damage and normal scans equal confusion, is not the only framework available to you. There is another way of understanding what is happening, one that is grounded in neuroscience, supported by evidence, and perhaps most importantly, one that points toward a direction of travel that is actually possible to walk.

In my experience, the moment people begin to genuinely consider this possibility, not just intellectually, but in the body, in the felt sense of what might be true, something begins to shift. Not the pain, necessarily. Not yet. But the relationship to it.

And that, in the end, is where recovery begins.

If this resonated with you, I've created a free guide that explores all five key reasons chronic pain persists and what you can gently do about it.

📥 "5 Key Reasons Your Pain Becomes Chronic, and How to Break Free"

And if you feel the need to put your experience into words, you can also write to me via Dear Therapist.

References

Brinjikji, W. et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816.

Jensen, M.C. et al. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine, 331(2), 69–73.

Moseley, G.L. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews, 12(3), 169–178.

Moseley, G.L. & Butler, D.S. (2013). Explain Pain. Noigroup Publications.

Nakashima, H. et al. (2015). Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine, 40(6), 392–398.

NICE (2021). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NICE guideline NG193.

Vlaeyen, J.W.S. & Linton, S.J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317–332.

Gordon, A. & Ziv, A. (2021). The Way Out. Vermilion.