Why MRI, CT, and X-Rays May Not Show the Cause of Your Low Back Pain

If you've ever struggled with persistent low back pain, you might have sought imaging like an MRI, CT scan, or X-ray to pinpoint the issue. Yet, often, these tests come back "clear" or "normal," leaving you with more questions than answers. How can this be, especially when the pain is so real?

The truth is that these imaging techniques, while valuable, have limitations—especially when it comes to identifying certain types of mechanical back pain. Some pain sources are dynamic, changing based on movement and position, which still images simply can’t capture. Here’s a look at why that might happen and how a more thorough approach, like the McGill Method, can help uncover the real mechanical cause of your pain.

1. Dynamic Disc Herniations

One reason imaging might miss the source of your pain is that some injuries, like disc herniations, are dynamic. A disc herniation can change position depending on the movement, such as bending forward (lumbar flexion) or twisting. In a static image—like an MRI taken while lying still—this dynamic herniation may not be visible, even though it causes pain in specific positions.

Imagine taking a picture of a car engine with the hood open and then trying to diagnose a problem that only happens when the car is running. A photo can’t show the movement and shifting that occurs with activity, and the same is true for certain types of disc herniations.

2. Fractures That Only Appear Under Traction

Another condition that imaging can miss is a specific type of fracture that only reveals itself when the spine is under tension, or traction. This means that, while lying down and relaxed during an X-ray, the fracture may not appear, even though it’s a real and painful issue. This can be misleading, as the absence of visible damage in the image may lead you to believe nothing is wrong, even when the pain is telling you otherwise.

3. Spinal Instability and Micromovements

Spinal instability, or micromovements, refers to small, often imperceptible movements between vertebrae that can cause significant pain. These micromovements may not be detectable in static imaging, as the slight shifts in the spine happen only during movement. Think of it like a loose hinge on a door; it may appear intact in a photo, but as soon as you try to swing the door, the instability becomes clear.

Static images like MRIs and X-rays are great for showing structural issues, but they’re limited when it comes to capturing instability or movement-based problems. In other words, an image taken while you’re lying still doesn’t reflect the spine’s response to real-life, dynamic forces and loads.

Why the McGill Assessment Matters

This is where the McGill Method, developed by Dr. Stuart McGill, becomes incredibly valuable. Unlike imaging, which provides a single snapshot, the McGill Assessment is a hands-on, movement-based assessment that evaluates how your spine behaves under various conditions and loads. It’s designed to uncover the mechanical cause of pain by identifying specific postures, movements, and loads that trigger discomfort.

The McGill Method assesses:

• How different movements affect pain: By testing various movements and positions, the assessment can identify if certain actions (like bending forward or lifting) worsen or improve your pain.

• Core stability: This involves assessing whether your core muscles are supporting your spine effectively and whether instability might be contributing to your discomfort.

• Your pain triggers and thresholds: The McGill Assessment examines what specific mechanical triggers—like flexion, extension, or rotation—cause pain, helping to tailor a more precise treatment plan.

Imaging as a Snapshot vs. Functional Assessment

Think of imaging as taking a single photo of your car’s engine. You might see general structures, but you wouldn’t be able to pinpoint which part only malfunctions under specific conditions, like when you’re accelerating. The McGill Assessment, in contrast, is like running a diagnostic test while the engine is on. It allows us to see how different components work together (or don’t) under actual load and movement.

Moving Beyond Static Images

If you’ve been frustrated by inconclusive imaging results, know that you’re not alone, and it doesn’t mean your pain isn’t real. Instead, it’s a sign that your pain source might be mechanical, rooted in the way your body moves and loads through different positions. With the McGill Method, we focus on identifying these specific causes and developing targeted strategies for pain relief and improved stability.

So, if your MRI, CT, or X-ray has left you without answers, consider a McGill Assessment to get a clearer picture of what’s really causing your back pain. A thorough assessment can reveal movement-based issues that imaging simply can’t capture, giving you the roadmap to a pain-free life that static images can’t provide.