Your MRI Is Lying to You: The Truth About Back Pain and Disc Herniations

In Episode 48 of the Movement Driven Podcast, Dr. Greg tackles one of the most common sources of confusion for people dealing with back pain: the MRI report. A scan that comes back with words like "herniated disc" can feel like a diagnosis and a verdict all at once — but according to Dr. Greg, it's rarely that simple.

Imaging Is Only Part of the Picture Dr. Greg explains that when someone comes in with back pain, the conversation itself does most of the diagnostic work. Ten to fifteen minutes of the right questions — when it hurts, what makes it worse, what makes it better, how it behaves during exercise versus rest — typically points him toward the top two or three likely causes before any hands-on assessment even begins. An MRI, when it's used, is one more data point layered on top of that picture. It's not the starting point, and it's definitely not the whole story.

Disc Findings Are Everywhere — Including in People With No Pain One of the most eye-opening points Dr. Greg makes is just how common disc herniations and bulges actually are. By age 40, a large share of the population already has them. By 50, it's roughly half. Most people are walking around with some kind of disc finding and never know it, because it isn't causing them any trouble. That's part of why an MRI showing a herniation doesn't automatically explain someone's symptoms — and why, in Dr. Greg's experience, it doesn't reliably predict who ends up needing surgery, either.

What's Actually Happening When a Disc Herniates Dr. Greg breaks down the anatomy in simple terms: a disc has a tougher, fibrous outer layer and a softer, gel-like center. A herniation happens when that gel-like material pushes through a tear in the outer layer. In many cases, it's the surrounding muscles going into protective spasm — not the disc itself — that accounts for most of the pain people feel.

Why Resting It Often Makes Things Worse When back pain flares, the instinct is to lie down and wait it out. Dr. Greg pushes back on that. Movement — even just walking — helps bring blood flow and relaxation to tissues that have tightened up defensively. Staying still, on the other hand, tends to prolong the guarding response and delay recovery.

When Surgery Actually Is the Right Call Dr. Greg is careful not to paint surgery as something to avoid at all costs. When a herniation is severe enough to cause loss of feeling or muscle function, or when a thorough trial of conservative care hasn't moved the needle, surgery can be the appropriate — and often successful — next step. The key, he says, is making sure the decision is based on the full clinical picture: symptoms, function, and objective findings together, not an MRI in isolation.

Dr. Greg's Guidance for Making Sense of Your MRI

• 
  Don't panic at the words on the report. A herniation or bulge on its own doesn't mean it's the cause of your pain.
• Keep moving. Gentle activity like walking supports healing more than bed rest does.
• Get a second opinion if something feels off — and take it seriously if that second opinion agrees with the first.

The Bottom Line An MRI is a useful tool, not a verdict. Understanding how your symptoms, your function, and your imaging fit together is what actually leads to the right treatment plan — not the report on its own.

If your MRI results don't quite match how you're feeling, or you want a second opinion grounded in a full evaluation rather than a single scan, book a free 15-minute discovery call or mention this podcast episode for a $79 first evaluation — a full hour, one-on-one with a doctor of physical therapy. Dr. Greg sees patients at both the Jacksonville and St. Johns locations. Visit movementdriven.com or call 904-257-5765 to get started.

🎧 Listen to the full episode on Spotify, Apple Podcasts, or YouTube.