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Wrinkles on the Inside

Wrinkles on the inside - a new way of thinking about normal changes that show up on medical tests like a MRI.

No doubt technology is improving and testing images are getting clearer. There is more to find on clearer pictures. Just like with new televisions, HD shows wrinkles and aging more clearly. As a result, it is so important to understand what may be “normal” as we age – like wrinkles on your skin.

Middle-aged with back pain.

You go to the doctor, who sends you for a MRI. Testing shows a bulging or herniated disc. You are told that it is not normal and could be causing your pain. You are given treatment options that include opioid medication, injections and surgery.

Treatment options, risks and results.

A lot of people that have undergone back surgery suffer from serious medical complications, need more surgery or end up with chronic pain. One quarter of people started on strong opioid pain medication end up with chronic abuse.

Studies show physical therapy treatment for back pain is as effective as other medical treatments. Physical therapy doesn’t expose you to the long term risks of other medical treatments. You will save time and it will cost you less.

The truth is that the bulging or herniated discs on the MRI are probably just normal changes.

The studies are clear – these are normal degenerative changes (bulging or herniated discs) that were there before the pain started. Like the normal wrinkles on our skin we get as we age.

The same is true for shoulder pain.

Degeneration is common. Compares shoulder MRIs of groups of middle-aged people with shoulder pain to a group without shoulder pain. Both groups will have the same number of rotator cuff tears. The two groups will have the same incidence of arthritis. Because both groups have the same number of tears and arthritis, the MRI findings are considered “normal changes” – like wrinkles on your skin.

Shoulder treatment studies show the same results – physical therapy as good as surgery.

Research shows good physical therapy for degenerative shoulder pain is as effective as surgery, and without the risk, time or cost needed to get better.

If you have knee pain and are middle-aged, consider your options carefully.

MRIs of groups of middle-aged people with knee pain and without knee pain will show the same rate of meniscus tears and arthritis. If there is no difference between the groups, the tears and arthritis are just “normal changes” – like wrinkles on your skin.

Studies on knee pain treatment show the same results – physical therapy is as good as surgery.

People that get good physical therapy recover at the same rate as those who have surgery – without the risk, while saving time and money. Studies show that for this type of knee pain, improvement is the same for people that have physical therapy compared to surgery. It’s just wrinkles on the inside.

More Information

This post was inspired by physical therapist Dr. Tim Flynn – and his YouTube video on the opioid epidemic as related to prescription for back pain based on normal MRI findings comparable to wrinkles on your skin (click here for video). Since initially writing this for our patient newsletter I have found other posts by Dr. Flynn with related YouTube videos. To link to his related YouTube video on normal hip degeneration click here. To link to his related video on normal disc and spine degeneration on MRI click here.

Christopher DiPasquale, PhD, PT, OCS, SCS, CHT is a physical therapist at Performance Physical Therapy & Sports Medicine with offices in Hebron and Colchester, Connecticut. He is board certified by the American Board of Physical Therapy Specialties in Orthopedic Physical Therapy and Sports Physical Therapy and a Certified Hand Therapist by the Hand Therapy Certification Committee.

For more information visit or call the office: Colchester 860-537-3014 or Hebron 860-228-4883

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