A Picture is Worth 1000 Words
Is a picture really worth 1000 words? Well, like most things, the answer is - it depends. Imagery can be a very valuable tool in enhancing and maximizing performance and healing, but seeing imaging (x-rays, CT’s, MRI’s) and reading imaging reports can unleash our minds in a way that isn’t all that helpful. Today’s technology has certainly given us amazing insight into our body’s structure and the detail of these images can allow us to see our internal anatomy - sometimes even in 3D! While these advances are exciting and important tools in our ability to diagnose conditions, perform surgeries, and determine the extent of trauma and injury, they also come packed with evidence for our mind about how we “should” feel, because to us humans, seeing really is believing.
One of the most frustrating things I have found for people who suffer from chronic or recurring musculoskeletal pain is that they feel there is often little “evidence” to support the amount of pain they are in because you can’t see it from the outside. People wish and hope for an MRI appointment and hold onto it as their knight in shining armour that’s going to prove once and for all to their doctor, family, and friends why they feel the way they do. When that fateful day finally arrives, I have seen over and over again, the amplified frustrations that result when people read their reports,which are often filled with minimizing words like “mild narrowing” “mild bulging” “minimal changes”, “unremarkable”. Our knight in shining armour has backfired on us! Rather than fuelling our argument about how we feel, it has instead provided evidence to the contrary. This leaves us questioning our body and how we feel - Why am I such a baby? Will my doctor think I’m crazy? Why can’t I handle it? Am I making it up? Is it all in my head?
If you have found yourself in this boat, let me assure you that no, you are not crazy, you are not making it up. Take comfort in the fact that the majority of people with joint pain are in the same boat as you. So how can this be? Well for starters, when we’re talking about pain - especially chronic pain, imaging findings are actually poorly correlated with the amount of pain the person is in. Sometimes the imaging is completely normal and the patient is in a lot of pain, other times we can see horrendous structural change on the image but the person doesn’t have any pain or only minor symptoms. So, to all of you with “normal” “mild” or “moderate” changes - the imaging doesn’t tell the whole story so don’t get too discouraged. Equally important, those with “advanced’ or “severe” changes noted - don’t let this one picture squash your hope, this doesn’t automatically dump you into a basket of never feeling better, or that you’re surely destined for invasive interventions. Remember, it is just one tool, and there are a LOT of other factors involved in healing and injury than what a picture can show us.
In some cases, the outcome and healing time is often “better” for those with more severe injury. Perhaps this is because the body pays more attention to getting busy healing itself, or with less damage we don’t see the inflammatory profile rise to the level that will also trigger it to fall. Think of rock climbing, the climber works their way up the rock face, higher and higher until they hit the bell at the top of route. Ringing the bell triggers the person below to start lowering them back down - until they are safely on the ground. If we don’t get high enough to ring the bell, we sometimes stay stuck on the wall and don’t trigger the inflammation to turn off - which, you guessed it, can keep it on.
Keep in mind as well, that still images just don’t capture the dynamic characteristics of movement and the dynamic characteristics of our tissues. In fact, most of our diagnostic testing - including imaging and the majority of blood work panels, give us a snapshot of the body in that one moment of time. Incredibly useful, but a snapshot is bound to also have limitations. A disc injury for example, may look minor when the person is lying on their back with their knees bent having their MRI, but it might not look the same when they bend over. We are dynamic, moving beings, so a still picture doesn’t capture the entire story, it’s just a sneak peek. Remember, imaging gives just the anatomy, not the physiology of what’s going on, or how our brain processes the information. There are so many factors that influence our experience of pain and much of these just can’t be quantified in a test. How we experience an injury is not ultimately dependent on the extent of tissue damage but probably more so by what else is going on in our life and what the “collateral damage” of this injury means for us. For example, our stress levels, our past experience with pain, the impacts the injury has on our social and vocational abilities; all of these affect how much - or how little we are affected by an injury (or perhaps illness). So next time you’re getting beamed up in a machine, smile nicely for your pictures, but don’t count on them to be your knight in shining armour or place all your eggs in the basket that this is the be all end all to your story. It’s just one tool, after all.