Your Diagnosis Doesn't Matter

You finally got your MRI and the results are back. You waited months for it (thanks Canadian healthcare system) and now have a report in your hands with a report full of terms like "L4/5 disc bulge", or “lumbar facet arthropathy”. You Google every term. You're convinced your spine is falling apart. Roll the credits, it’s over folks.

I need you to hear this: that MRI report only labels your pathology. It doesn’t tell you what to do about it. This newsletter is going to try to convince you that your diagnosis doesn’t matter. Let me explain.

A 2025 review study found that classifying back pain by its underlying mechanism (how the pain is provoked and experienced) predicts what will help you far better than a diagnostic label like "herniated disc" or "stenosis" [1]. The better first question isn't "what does my scan show?" It's "what kind of pain do I actually have, and what movement makes it worse?".

I don't mean to sound overly critical, or rude, but after reading through posts on Reddit pages and different blogs of people describing their journeys and experiences with back pain, I think a lot of people have an obsession with the label of their diagnosis. I've even read instances where people talk about suffering from extreme pain for 15 months and going to numerous different specialists, wanting more than anything to figure out what is wrong with their back. They spend months waiting for appointments until they’re passed on to the next specialist. These precious months could have been used to rebuild their capacity and learn how to stop poking the bear.

Why your MRI label is the wrong question

An MRI describes anatomical abnormalities (or lack thereof), not pain.

Imaging studies have found disc bulges, degeneration, and annular fissures on the scans of people with zero back pain, and the rates climb steeply with age [2]. A 40-year-old with no symptoms has roughly a 50% chance of a disc bulge showing up on imaging and a ~68% chance of finding disc degeneration [2]. These findings in a 40-year-old with back pain get circled in red and handed over as an explanation for their pain. If abnormalities can exist without pain and pain can exist without abnormalities, then diagnosis from imaging is not always a reliable means to the truth. See what I’m saying?

The MRI isn't useless. It can identify potential causes of disability but should be treated as context rather than singular truth. It doesn't tell you whether loading your spine, extending it, or sustained flexion are pain-provoking, and it doesn’t tell you what to do about it. Two people with the same MRI report can require different approaches.

What actually drives what you should do: pain mechanism

The structure on your scan doesn't dictate the plan. The way your pain behaves does.

This concept clicked for me during my PhD comprehensive exams. I was reviewing long papers about the mistreatment of spinal health. Clinical practice needs to catch up to the evidence-based recommendations of conservative treatment first, and potential imaging later after conservative options have been exhausted.

The over-reliance of our medical systems on imaging causes massive delays in diagnosis and treatment for those with pathologies that truly need it, and introduces red herrings in the treatment and rehab process for back pain. Biomechanically, the spine doesn’t care what a radiologist circles on your scans. It cares how, how much, and when forces are applied to spinal structures. Conservative treatment should be the first-line choice for everyone if there are no red-flag symptoms or suspected blunt force trauma injuries.

Side note, the stress and grind of studying back pain at my desk each day gave me back pain flare-ups. The irony…I know.

What to do instead of chasing a diagnosis

1. Tag your pain to a movement, not a structure. For a couple days, write down which positions provoke pain and which positions settle it.
2. Identify your directional preference. Most nociceptive (mechanical) and neuropathic (nerve-related) back pain has one. Flexion (bending forward), extension (standing straight up or extending backwards), or neither. This is basically an additional part to number 1, spend a couple minutes testing gentle repeated movements in each direction and note where and when you experience pain.
3. Rate your nervous system load. Start paying attention to your sleep quality, stress level, and pain. These are often more related than you may think.
4. Adjust the inputs you control. Review your daily postures at work and at home and see if there is potential to improve your postures using sensible ergonomics before buying anything. Most gains come from 2 or 3 habit changes, not new furniture or desks.
5. Consider one of my programs. You can follow a matched plan that fits your pattern and get you moving again.

*Please note: This doesn't replace a clinician for red-flag symptoms. But it does replace sitting around waiting for someone to explain your MRI in a way that finally tells you what to do with your body. That explanation is usually not coming. The scan is a photograph. What you need is a plan that responds to how your pain behaves this week.

Best,

Mitch

Want to know which back pain pattern matches you? Take my free 2-minute quiz and find out.

Educational content, not medical care. Red-flag symptoms (bowel/bladder loss, unexplained weight loss, fever, recent trauma): see a physician immediately.

References

[1] Tedeschi et al., 2025: https://pubmed.ncbi.nlm.nih.gov/39860418/

[2] Brinjikji et al., 2015: https://pubmed.ncbi.nlm.nih.gov/25430861/