Back Pain: MRI Scans May Reveal Internal Wrinkles, Too


Physical therapy is extremely beneficial for people suffering from back or neck pain. During the diagnosis, patients tend to ask a variety of questions regarding MRI imagery. These tests can reveal many details about the injury, and patents tend to express curiosity about the findings. As a clinician, I believe that it is very important to communicate clearly with patients about the results of their MRI scan. Patients tend to appreciate the opportunity to learn about the differences between normal areas and the injured tissues appearing in the imagery. Many patients are initially confused about which area is considered normal, and this is especially true when the image shows signs of wrinkling due to the normal aging process.

Are They Wrinkles, or Something Else?

Patients who are unfamiliar with MRI imagery may assume that normal areas are abnormal. This tendency is especially prevalent in patients who are not familiar with the signs of a herniation, bulged or degenerative disc. Fear around these potential conditions may also affect the patient’s ability to understand what the imagery is actually presenting. When there are signs of internal changes present, this can exacerbate the misunderstandings about the nature of disc degeneration, which is a normal part of the aging process for many individuals. It is helpful at this point to explain to patients that external wrinkles on the face should not cause any concern, and the same can be true for certain types of internal changes in the spinal area as well.

Many types of minor subluxations and disc degeneration are comparable to external facial wrinkles. They are visible on the MRI, but they do not cause any pain. They are also able to slightly distort the imagery so that the untrained eye might anticipate a diagnosis that is worse than the real situation, which is often manageable. For example, a study conducted in 2014 showed clearly that 80 percent of patients who were over the age of 50 showed signs of degeneration in some of their discs. None of the patients in the study were experiencing any type of localized or referral pain. The changes in their spine were comparable to the changes in their faces. Wrinkles on the face caused no pain, and neither did the slight degeneration shown in the MRI imagery.

Physical Therapy Evaluations

Determining the source of any low back pain is a process that requires clinicians to possess a high level of skill and accuracy. If there are signs of disc degeneration, the practitioner must be able to identify this internal sign of aging as a kind of internal wrinkle and look for additional anomalies.

Communication with the patient is also critical at this time. Lesions in the proximal nerves may not be visible on the MRI, and these can be caused by movement patterns, holding patterns or chronic stress. A complete evaluation by a skilled clinician can discover the most likely contributing elements, which allows the practitioner to recommend a course of treatment that addresses the root causes of the pain.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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