Top 5 Fridays! 5 Educational Pieces Against Radiology to Predict Pain | Modern Manual Therapy Blog

Top 5 Fridays! 5 Educational Pieces Against Radiology to Predict Pain

courtesy of WebMD
ouch! Check out all that red!

Those of us who have taken courses in Pain Science and keep up with research in that realm know that what your body part looks like while you are lying in a tube does not correlate well with how someone feels and moves.

Despite this, many patients present on initial evaluation with many Thought Viruses that come with having x-rays, CT Scans and MRIs. Here are some ways I educate them that these findings are normal in many cases.

1) Intermittent Pain
  • with the exception of central sensitization or acute traumatic injury, most patients have intermittent pain, and almost all patients have varying intensities of pain
  • through enough questioning and answering, many patients come to realize that even their 9-10/10 pain is intermittent in nature
  • once they realize it comes and goes, you explain that is great news!
  • that means there are times when your nervous system is not being as vigilant as the times, positions, and movements when you are in pain - these times can be extended
  • in regard to the scans, "Do you think your MRI looks better in the morning, and worse as the day goes on?"
2) Degeneration
  • many patients are fearful of the degeneration that appears on their scans
  • educate them that this appears as early in pain free individuals as their 20s or even earlier depending on their activity level
  • having one knee with "degeneration and pain" is like saying that knee is older than the pain free one
  • I love David Butler's saying that degenerative changes are the "kisses of time"
  • one study that x-rayed both the painful and non-painful knee found that both had equal amounts of changes and in some cases the non-painful one appeared worse
3) Discs
  • if a patient is stuck on the D word, you can tell them that repeated motions have been shown to decrease protrusions
  • and herniations eventually resorb after a few months
  • if you can get their mind off of discs, tell them that up to 87% of males/females in their 20s had disc herniations - that's pretty much normal!
4) Running
  • many doctors and patients believe that running is bad for the knees
  • one study showed that if people ran at any point in their lives (including not currently running), they ended up having less changes in their knees upon x-ray than people who never ran at all
  • improper training may cause knee pain or different gait variables, loss of ability to load, or asymmetries in gait or over stride may cause knee pain, but these are correctable
  • walking causes back pain and knee pain sometimes, but no one says walking is bad?!?
  • running is really just thousands of little hops, is hopping bad for you?
5) Pinched Nerves
  • nerves are very resilient and very strong
  • they are designed to be stretched, compressed, and moved in many different directions, basically any way your body can move, nerves do as well!
  • the largest nerve in your body (most likely one that most patients know), your sciatic nerve gets sat on all day and until you have leg pain, it's not an issue, so compression is not the problem
  • the nerve roots get pinched a bit every time you rotate and sidebend, or in other words move!
  • whatever your spine looks like currently on MRI, it also looked like the day before you had pain as these changes take years to develop as long as there was not major trauma
These are some of my more commonly used educational pieces to inoculate against Thought Viruses. I developed a series of posters recently on Thought Viruses and sell them on EDGE Mobility System. Check them out! They are designed for the waiting and exam room to help develop a Pain Science Education Q&A session.

Interested in live cases where I apply this approach and integrate it with manual therapy and repeated motions? Check it out on The OMPT Channel!

Keeping it Eclectic...


  1. Two of my favorites:
    1. My doctor told me I have fibromyalgia
    2. My doctor told me PT wouldn't help.
    Thanks Doc!

  2. Great Post Dr. E. I will definitely start using the "kisses of time." I also tell patients that degeneration can be viewed as internal gray hairs. Just as the body ages externally, internal changes naturally occur with aging as well.

  3. Good one! Also like wrinkles on the inside.