Why Disc Bulges and “Abnormal” MRI Findings May be Normal and How Physical Therapy Can Help

If you’ve ever had an MRI for back or neck pain, hearing that you have a disc bulge, degeneration, or other structural change can understandably be alarming. It’s natural to think that something on a scan must be the cause of your pain — and that surgery might be the only solution.

But research tells a very different story.

A major review published in the American Journal of Neuroradiology found that many MRI “abnormalities” are actually extremely common — even in people with no symptoms at all. This has huge implications for how we think about back pain and why physical therapy (PT) is often a better first step than jumping straight to surgery.

MRI Imaging Changes Are Common — Even Without Pain

The AJNR review looked at data from over 3,000 asymptomatic adults (people who didn’t report any back pain) across multiple studies. It shows that degenerative findings, such as disc bulges on MRI increase with age — even in people who feel perfectly fine:

Disc degeneration

• Found in 37% of asymptomatic 20-year-olds 
• Seen in 96% of asymptomatic 80-year-olds

Disc bulges

• Present in 30% of asymptomatic 20-year-olds 
• Present in 84% of asymptomatic 80-year-olds

Disc protrusions

• Present in 29% of asymptomatic 20-year-olds 
• Present in 43% of asymptomatic 80-year-olds

 Annular fissures (tiny tears)

• Found in 19% of asymptomatic 20-year-olds 
• In 29% of asymptomatic 80-year-olds 

These numbers show that structural changes on scans are part of the normal aging process — not necessarily a medical emergency or a guaranteed source of pain.

Why These Findings Or Disc Bulges Don’t Automatically Mean Surgery

Here’s the key point: seeing something on an MRI is not the same as that thing causing your pain.

The AJNR review highlights that many of these changes:

• Increase with age, even in pain-free individuals 
• Are often unrelated to actual symptoms 
• Should be interpreted in the context of the clinical picture — not in isolation 

That’s why surgeons and clinicians generally consider surgery only in specific situations, such as:

• Progressive weakness or loss of function 
• Severe nerve compression with neurologic symptoms 
• Lack of improvement after a focused course of conservative care 

For most people, conservative treatment like physical therapy leads to excellent outcomes without the cost, risks, and recovery time associated with surgery.

How Physical Therapy Helps — Even When MRI Findings Look “Bad”

Physical therapists don’t treat imaging findings — they treat people. That’s a big distinction. PT focuses on reducing pain and improving movement, strength, and function regardless of what an MRI might show.

Here’s what PT does well:

🧠 1. Improves Movement and Load Management

Even if an MRI shows a disc bulge or degeneration, many people hurt because of how their muscles, joints, and nervous system move and respond — not because of the structural change itself. PT targets movement patterns that reduce stress on the spine.

💪 2. Builds Strength and Stability

A stronger core and better movement control helps your body tolerate daily activities more easily — reducing symptom flare-ups and improving long-term outcomes.

⚖️ 3. Helps the Body Adapt and Heal

Many disc bulges improve on their own over time. Additionally, physical therapy supports this natural process by keeping you active and functional rather than immobilized.

🧘 4. Addresses Sensitization and Pain Response

Pain is not just structural — the nervous system plays a major role. PT uses graded exposure, education, and pain science principles to retrain your body’s response to movement.

Real Stories: Evidence Meets Everyday Recovery

Imagine two people, both age 50:

• One has a disc bulge on MRI and no pain. 
• The other has the same bulge but experiences discomfort. 

Why the difference? Because pain is about how your body moves and responds — not just what shows up on a scan.

That’s where PT shines. Rather than reacting to the image, PT focuses on function, movement confidence, and meaningful recovery.

Bottom Line: Don’t Panic About the Picture — Focus on Progress

For instance, if your MRI shows disc bulges, degeneration, or other changes:

• It doesn’t automatically explain your pain 
• It doesn’t mean you need surgery 
• It doesn’t dictate your treatment plan 

Instead, use your clinical symptoms, physical exam findings, and how your body moves and feels to guide treatment — and physical therapy is one of the most effective starting points for recovery.

That’s good news — because most people improve remarkably with PT, returning to activities they love without ever needing surgery.

Contact us today to schedule an evaluation with a physical therapist and discuss your own MRI findings to find a personalized solution to your pain.