You are more than your image! No, I’m not talking about how your viewed by others, but rather how you are viewing your imaging (MRI’s, X-rays and other diagnostic measures.)
Let’s use an analogy for reference here; If we looked at a picture of a group of musicians in this quartet could we presume how they will play?
If we next look at the picture of football players bellow, can we be certain we know how they will play?
The answer is obvious to those whom know enough about or recognize the musicians or the team pictured. Perhaps to them, it’s obvious, but to others not in the “know,” it is less clear. If I replaced these 4 musicians with 4 middle school children, more of us would agree that they would probably not play as well. If I replaced some of the bigger team members with some 150 lbs players, maybe we could state they wouldn’t play so well, but again it’s an assumption or a best guess.
Truth be told, unless I photoshop out the instruments completely or 8/11 players and physically remove them, we cannot conclusively say that performance will be horrible.
Let’s take this lens and apply it to the interpretation of imaging. Doctors are experts in the field at analyzing such images and any deviation in structure has valid reason to cause concern but it doesn’t show the whole picture ( pun intended). Often times, the two-dimensional information shared to patients is about the damaged structure and we myopically focus in on that as the source of all the problems without considering the complex other systems at work that can help. Next we catastrophize the inability to return to healthy activity without pain for the rest of our life, or until surgery corrects said deviation. It’s easy to assume that if thats broken, so are we.
Thankfully in most situations, that simply isn’t the case. As we can see from a excerpt of a study on the prevalence of disc injuries of non symptomatic people; not everyone who has pain has a damaged structure and not everyone with a damaged structure has pain therefore an image can only be so powerful prognostically. This meta analysis showed that amongst 20 years olds who explicitly reported having no back pain but who’s back were still imaged, showed 37% had a disc bulge. This number increase to 96% of an elder population 80 years or older
Like a missing KEY football player such as the QB, there are certain structures that conclusively we need and would be very problematic if missing or disfigured. However we can’t universally appraise that exception to every case. Those cases are far fewer than we like to think, and even then, the body seems to always find a way.
The point I’ve hopefully made is that the layers of complexity of movement needs/ adaptation go way deeper than the superficial snapshot we sum them up as. Torn labrums in the hip and shoulder are also very prevalent amongst people not in pain, they more likely have found a way to saliently stabilize against their life needs and may never have a need to go to the doctor. Perhaps your ( insert diagnosis) had been with you for many years. However it wasn’t until a recent acute injury or increase in demands on the system that you felt pain. When the area is imaged, it’s clear that a structure involved isn’t functioning properly or has a disfigurement so alas! We have found the problem….. No…… This is a moment to use other tests such as movement based tests or strength assessments to ensure we are assessing and not assuming; remembering that correlation does not always mean causation. Let’s see the players out on the field before making our bets on their playing ability. Let the musicians notes steer our presumptions.
Questions about your imaging? Worried about a surgery and want a second opinion? Come in and check out Center for Spine and Mobility and well ensure you have more information as to your needs and prognosis.
