Functional vs structural causes, common imaging pitfalls.
Published by Dr Oliver Khoo at Monday, December 22, 2025
Magnetic Resonance Imaging (MRI) is often seen as the gold standard when it comes to diagnosing pain. Many people expect that once they have an MRI, the answer to their discomfort will be obvious — a bulging disc, a torn muscle, or some other clear structural problem.
But for a large number of people, the results come back with words like “normal,” “age-related changes,” or “no significant findings.” This can be confusing and even frustrating, especially when the pain is very real and affecting daily life.
So why does this happen? And more importantly, what does it mean for your recovery?
The answer often lies in understanding the difference between structural problems and functional causes of pain, as well as recognising the limitations of medical imaging.
MRI scans are excellent at identifying structural changes in the body. These include:
When pain is directly caused by a clear structural issue — such as a fracture or acute disc injury — MRI can be extremely useful.
However, many people experience ongoing pain without any obvious structural damage.
Functional pain relates to how the body moves, loads, and coordinates, rather than what it looks like on a scan. These issues don’t show up clearly on MRI because they involve movement patterns, muscle timing, nervous system sensitivity, and biomechanics.
Examples of functional contributors to pain include:
In these cases, the pain is real — but the problem is dynamic, not static. MRI captures a still image, not how your body behaves in real life.
One of the biggest misconceptions is that a normal MRI means there is no problem. In reality, it often means there is no visible structural damage — not that the body is functioning optimally.
Many people with significant pain have MRIs that appear normal, while others with severe-looking scans feel no pain at all.
MRI reports frequently mention findings such as:
These changes are extremely common and often appear in people without any pain whatsoever. They are similar to wrinkles on the skin — part of normal ageing rather than a definitive cause of symptoms.
When these findings are overemphasised, they can create unnecessary fear and confusion.
Pain is not purely a mechanical issue. The nervous system plays a major role in how pain is experienced.
MRI cannot show:
This is why pain can persist long after tissues have structurally healed.
MRI is taken while lying still. However, many people experience pain:
These symptoms are often related to movement strategies and load management, which cannot be assessed through static imaging alone.
Pain is a complex experience influenced by multiple systems in the body. It is not always a direct signal of damage.
Some key contributors include:
Understanding this shifts the focus from “What’s broken?” to “How is my body functioning?”
MRI remains an important diagnostic tool when used appropriately. It is particularly valuable when:
The key is ensuring imaging findings are interpreted in context, alongside a thorough clinical assessment.
A comprehensive clinical assessment looks beyond the scan and considers:
This approach helps identify functional drivers of pain that imaging alone cannot reveal.
When pain is approached purely from an imaging perspective, recovery can stall. When it is approached from a functional and movement-based perspective, outcomes often improve significantly.
Effective rehabilitation may involve:
Pain becomes something to understand and manage, rather than something to fear.
Degenerative changes can appear earlier than expected and are often influenced by genetics, lifestyle, and activity history. These findings are common and do not automatically explain pain.
No. Pain is a real experience created by the nervous system. A normal MRI simply means there is no visible structural damage — not that the pain is imagined or invalid.
Repeat imaging is rarely helpful unless symptoms have changed significantly or new red flags are present. Functional assessment and targeted rehabilitation are often more effective.
Yes. Many people with “abnormal” scans recover fully when movement, strength, and load tolerance are addressed appropriately.
This varies depending on the individual, pain history, and contributing factors. Consistency and gradual progression are more important than speed.
MRI scans are powerful tools, but they are only one piece of the puzzle. Pain is rarely explained by structure alone. Understanding functional contributors, movement patterns, and nervous system responses often provides far greater clarity — and a clearer path forward.
If your MRI hasn’t given you answers, it doesn’t mean you’re out of options. It may simply mean the solution lies beyond the scan.
