What does research show us about our imagining findings and how learning about your education and getting back to moving helps your pain, but more importantly gets you back to doing what you love

Did you know there is countless studies throughout the body showing people with imaging findings that should show tissue issues, but they are completely pain free?

Neck Findings

Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers

Eijiro Okada, Morio Matsumoto. Corresponding author 1 Hirokazu Fujiwara, 2 and Yoshiaki Toyama

  • The percentage of subjects with degenerative changes in the cervical discs was 98.0% in the lumbar disc herniation group and 88.5% in the control group (p = 0.034)

Normal morphology, age-related changes and abnormal findings of the cervical spine. Part II: Magnetic resonance imaging of over 1,200 asymptomatic subjects
Fumihiko Kato 1, Yasutsugu Yukawa, Kota Suda, Masatsune Yamagata, Takayoshi Ueta

  • The relatively high prevalence of abnormal MRI findings of the cervical spine in asymptomatic individuals emphasizes the dangers of predicating operative decisions on diagnostic tests without precisely correlating these findings with clinical signs and symptoms.

Neck pain in demolition derby drivers
Alexander C Simotas 1, Timothy Shen

  • The majority of participants reported some postevent symptoms. However, on the average, neck pain always lasted less than 3 weeks and was mild or absent for most drivers. Even worst-event neck pain lasted more than 3 weeks for only 10% of the drivers. Arm pain was rarely reported (only 15% even in the worst-case event). Despite 1632 collisions, only 8% had mild chronic neck pain, and the remainder had no chronic neck pain.
  • Three drivers reported having mild chronic persistent neck pain (never went away) as a result of derby participation, but the remaining 37 respondents reported no chronic neck pain

Low Back Findings

MRI findings in the lumbar spines of asymptomatic elite junior tennis players

G Rajeswaran 1, M Turner, C Gissane, J C Healy

  • The lumbar spine MRI studies of 98 asymptomatic junior elite tennis players (51 male, 47 female) with a mean age of 18 years (age range 11.2-26.3 years; standard deviation 3.1) was reviewed by two consultant musculoskeletal radiologists using consensus opinion. Images were assessed using accepted classification systems
  • Facet joint arthropathy occurred in 89.7% of the players, being mild in 84.5% of cases. There were 41 synovial cysts in 22.4% of the cohort all occurring in the presence of facet arthropathy. Disc degeneration was noted in 62.2 % of players, being mild in 76.2% of those affected. Disc herniation was noted in 30.6% of players, with 86.1% of these being broad based and 13.9% being focal. There was nerve root compression in 2%. There were 41 pars interarticularis abnormalities in 29.6% of patients, 63.4% of these being grades 1-3. There was grade 1 spondylolisthesis in 5.1% of players.Normal morphology, age-related changes and abnormal findings of the cervical spine. Part II: Magnetic resonance imaging of over 1,200 asymptomatic subjects


Systematic literature review of imaging features of spinal degeneration in asymptomatic populations

W Brinjikji 1, P H Luetmer 2, B Comstock 3, B W Bresnahan 4, L E Chen 4, R A Deyo 5, S Halabi 6, J A Turner 7, A L Avins 8, K James 4, J T Wald 1, D F Kallmes 1, J G Jarvik 9

  • Thirty-three articles reporting imaging findings for 3110 asymptomatic individuals met our study inclusion criteria. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals.
  • Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.

Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis

Ming Zhong 1, Jin-Tao Liu 2, Hong Jiang 2, Wen Mo 3, Peng-Fei Yu 2, Xiao-Chun Li 2, Rui Rui Xue 3

  • The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH.


Abnormal findings on magnetic resonance images of asymptomatic shoulders
J S Sher 1, J W Uribe, A Posada, B J Murphy, M B Zlatkin

  • Magnetic resonance images of the shoulders of ninety-six asymptomatic individuals were evaluated to determine the prevalence of findings consistent with a tear of the rotator cuff.
  • The over-all prevalence of tears of the rotator cuff in all age-groups was 34 per cent (thirty-three). There were fourteen full-thickness tears (15 per cent) and nineteen partial-thickness tears (20 per cent).
  • The frequency of full-thickness and partial-thickness tears increased significantly with age (p < 0.001 and 0.05, respectively).
  • Twenty-five (54 per cent) of the forty-six individuals who were more than sixty years old had a tear of the rotator cuff: thirteen (28 per cent) had a full-thickness tear and twelve (26 per cent) had a partial-thickness tear. Of the twenty-five individuals who were forty to sixty years old, one (4 per cent) had a full-thickness tear and six (24 per cent) had a partial-thickness tear.
  • Magnetic resonance imaging identified a high prevalence of tears of the rotator cuff in asymptomatic individuals. These tears were increasingly frequent with advancing age and were compatible with normal, painless, functional activity. The results of the present study emphasize the potential hazards of the use of magnetic resonance imaging scans alone as a basis for the determination of operative intervention in the absence of associated clinical findings

Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender
C Milgrom 1, M Schaffler, S Gilbert, M van Holsbeeck

  • Our results indicate that rotator-cuff lesions are a natural correlate of ageing, and are often present with no clinical symptoms. Treatment should be based on clinical findings and not on the results of imaging.




Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study
Brad Register 1, Andrew T Pennock, Charles P Ho, Colin D Strickland, Ashur Lawand, Marc J Philippon

  • The purpose of this study was to assess a cohort of asymptomatic people to determine the prevalence of hip lesions.
  • Labral tears were identified in 69% of hips, chondral defects in 24%, ligamentum teres tears in 2.2%, labral/paralabral cysts in 13%, acetabular bone edema in 11%, fibrocystic changes of the head/neck junction in 22%, rim fractures in 11%, subchondral cysts in 16%, and osseous bumps in 20%.
  • Magnetic resonance images of asymptomatic participants revealed abnormalities in 73% of hips, with labral tears being identified in 69% of the joints.


Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI
Laura M Horga 1, Anna C Hirschmann 2, Johann Henckel 3, Anastasia Fotiadou 3, Anna Di Laura 3, Camilla Torlasco 4, Andrew D'Silva 5, Sanjay Sharma 5, James C Moon 4, Alister J Hart 3

  • MRI showed abnormalities in the majority (97%) of knees. Thirty percent knees had meniscal tears: horizontal (23%), complex (3%), vertical (2%), radial (2%) and bucket handle (1%). Cartilage and bone marrow abnormalities were prevalent at the patellofemoral joint (57% knees and 48% knees, respectively).
  • Moderate and severe cartilage lesions were common, in 19% and 31% knees, respectively, while moderate and severe bone marrow oedema in 19% and 31% knees, respectively.
  • Moderate-intensity lesion in tendons was found in 21% knees and high-grade tendonitis in 6% knees-the patellar (11% and 2%, respectively) and quadriceps (7% and 2%, respectively) tendons being most affected.
  • Three percent partial ligamentous ruptures were found, especially of the anterior cruciate ligament (2%)

Is It Really As Simple As Learning That Pain Is A Guide and Not A Master

Then Finding A Pain Free Movement and Doing It Routinely?

Preoperative therapeutic neuroscience education for lumbar radiculopathy: a single-case fMRI report
Adriaan Louw, PT, PhD1, Emilio J. Puentedura, PT, DPT, PhD2, Ina Diener, PT, PhD3, and Randal R. Peoples, MS, MD4

*I typically do not look at case reports, but the focus here is on the brain scan changes

  • The message of this case study is powerful for the physical therapist treating spinal pain patients, by underscoring the importance of education in leading to immediate changes in cognitions, ROM and beliefs regarding a patient’s perception of injury, treatment and potential recovery

A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability
Lianne Wood, Paul A Hendrick 

  • This review demonstrates moderate level evidence that the use of pain neuroscience education alongside physiotherapy interventions probably improves disability and pain in the short term in chronic low back pain. These results provide greater support for the addition of pain neuroscience education in routine physiotherapy practice in chronic low back pain

Neurophysiological Pain Education for Patients With Chronic Low Back Pain: A Systematic Review and Meta-Analysis
Heidi Tegner, Pernille Frederiksen, Bente A Esbensen, Carsten Juhl 

  • There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. NPE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP

The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature
Adriaan Louw, Kory Zimney, Emilio J Puentedura, Ina Diener

  • Current evidence supports the use of PNE for chronic MSK disorders in reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization
Link To The Paper With The Brain Scan Changes

Home Work

Pull up the course calendar

This week we will be focused on trying to do 3 mins of cardio for 4 days. Reference Week 2 in your pain Recovery Weekly Calendar


Pain Recovery Weekly Calendar

We are excited about what this class will do to reframe how you look at pain, which will get you back to doing the things you love in daily life again

We are so proud of you for undertaking this course and taking your pain head on

This process can be a lot, so do not hesitate to slow down to your own pace. You are not alone. If you are stuck and need more help do not even hesitate to reach out to us.  

Your life is waiting for you again on the other side of this course, till next time guys 🙂

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