If my MRI doesn't show anything serious, why does my back still hurt?
Why Your Back Can Hurt Even When Your MRI Looks Normal
What I tell patients when the scan looks "normal" but the pain is still there.
There's one question I hear in clinic more than almost any other.
If my MRI doesn't show anything serious, why does my back still hurt?
It usually comes with frustration. The scan was supposed to provide an answer. Instead, it often creates more questions.
A major review published in JAMA this month gave one of the clearest explanations I've read, and I think it's something every patient should understand.
619 million people worldwide live with low back pain
90% of low back pain is "nonspecific," with no single cause
#1 global cause of years lived with disability
Most back pain can't be explained by one finding on a scan
What surprises many people is that around 90% of low back pain is classified as nonspecific. That means there usually isn't one disc, one joint or one nerve that fully explains why someone is in pain.
That doesn't mean the pain isn't real. It means the pain usually isn't one broken part. It's a system under strain.
That's why two people can have very similar MRI findings and completely different levels of pain.
Why a scan can be misleading
Bulging discs, arthritis and other age-related changes are common, even in people who have no back pain at all. Finding one of these changes on an MRI doesn't automatically mean you've found the cause of the pain.
Likewise, a scan that doesn't show a clear cause doesn't mean nothing is wrong. A scan is one piece of information. It isn't the whole story.
And here's the part I most want you to hear. If your scan doesn't show a serious structural problem, that's often reassuring. It also means there are usually effective treatments that don't involve surgery.
Your spine isn't one instrument. It's an orchestra.
If one violin is slightly out of tune, the music changes. But sometimes the problem isn't one instrument. It's how the whole orchestra is working together.
Your back works in a similar way. Muscles, joints, discs, the nervous system, sleep, stress, previous injuries and physical activity all influence how pain is experienced.
Looking for one cause on an MRI is often like blaming a single violin for an entire orchestra playing poorly.
So what does the evidence support?
For recent back pain.
Keep moving. This is the single most important thing. Stay as active as your symptoms allow.
Avoid prolonged bed rest. Resting too long tends to slow recovery.
Heat can help.
Anti-inflammatory medication may help some people, if appropriate.
Hands-on treatments, including spinal manipulation, may provide relief for some patients.
Most episodes improve over time.
For persistent back pain.
Regular exercise, tailored to you. This is the cornerstone.
Education about pain.
Addressing sleep, stress and overall health.
Psychological approaches such as cognitive behavioural therapy for appropriate patients.
Combining several approaches rather than relying on one treatment alone.
The review also suggests that routine imaging, long-term opioid use, and many invasive procedures have limited benefit for most people with ordinary nonspecific low back pain.
My takeaway
If your MRI came back "normal" but your back still hurts, it doesn't mean the pain isn't real. It doesn't mean you're imagining it. And it doesn't mean no one can help you.
Often, the next step isn't another scan. It's understanding how your whole system is working, and helping it recover. That's where good clinical assessment, movement, education and an individual treatment plan can make a real difference.
Reference
Cashin AG, Chou R, Weimer MB, McAuley JH. Low Back Pain: A Review. JAMA. Published June 15, 2026. DOI: 10.1001/jama.2026.9631.
This newsletter is for general education and should not replace an individual medical assessment. Seek urgent medical care if you develop new leg weakness, loss of bladder or bowel control, fever, unexplained weight loss, or other concerning symptoms alongside back pain.
Until the next signal,
Dr Erik Rudberg, DC
Most people wait for pain. The attentive ones notice the signal.
