Neck and back pain is one of the most common reasons people seek medical care, yet it is also one of the most misunderstood. Many people with chronic neck pain or lower back pain are told their MRI explains everything, even when the explanation does not match what they feel day to day. Others are left confused when the MRI results appear “normal,” but their pain continues to limit sleep, work, and their quality of life.
This disconnect creates frustration and fear. People begin to wonder if their neck and back pain is permanent, if something was missed, or if they are running out of options. When neck and back pain is judged by imaging alone, important details about how the spine, joints, nerves, and nervous system are working together are often overlooked.
The reality is that MRIs are designed to show structure, not pain. They can identify disc bulges, herniations, and age related changes, but they cannot explain inflammation, joint irritation, muscle guarding, or how the nervous system processes pain signals. This is why MRI findings often fail to explain ongoing neck pain or back pain, especially after injury or prolonged stress.
Understanding why MRIs miss your pain changes the conversation entirely. It shifts the focus away from fear based labels and toward how pain is actually generated and maintained in the body. With the right explanation, neck and back pain becomes something that can be understood, evaluated properly, and addressed with clarity instead of guesswork.
Why MRIs Often Miss the Source of Neck and Back Pain
MRIs are excellent tools for showing the structure of the spine, including bones, discs, and the space around the spinal cord. They are often used to look for disc herniations, spinal stenosis, or other visible changes that may contribute to neck pain or back pain. However, an MRI is a snapshot of anatomy, not a measure of how pain is actually being generated.
Pain does not come from structure alone. Neck and back pain are influenced by inflammation, joint irritation, muscle guarding, and how the nervous system responds to injury or stress. These factors do not always appear on MRI images, which is why many people experience ongoing pain even when scans look mild or “normal.”
Another reason MRIs miss pain is that many common findings are not the true source of symptoms. Disc bulges, disc degeneration, and age related changes are frequently seen in people who have no neck or back pain at all. When imaging findings are treated without matching them to symptoms and physical exam results, the real cause of pain is often overlooked.
This is why imaging should never be used in isolation. To understand neck and back pain accurately, MRI findings must be combined with a detailed history, a physical exam, and an evaluation of how the spine and nervous system function together. Without that context, imaging can create more confusion than clarity.
Disc Problems vs. Joint Problems: What Actually Causes Neck and Back Pain
One of the most important distinctions Dr. Christopher Gleis, MD, Pain Management Specialist in Tampa Florida, explains to patients is the difference between disc problems and joint problems in the spine. While MRIs often highlight disc bulges or herniations, those findings do not automatically explain neck and back pain. In many cases, discs look concerning on imaging but are not the true source of symptoms.
Discs act as spacers and shock absorbers between the bones of the spine. When a disc shifts or herniates, it only becomes a major concern if it significantly compresses a nerve. As Dr. Gleis explains, many people have multiple disc herniations and no pain at all, while others have pain without meaningful nerve compression.
Joint pain, on the other hand, behaves very differently. The joints in the neck and lower back move constantly and are especially vulnerable to injury during accidents, sudden impacts, or repetitive strain. These joints can become inflamed, swollen, and painful, even though they are too small to clearly show damage on an MRI.
Dr. Chris Gleis emphasizes that joint inflammation is most often diagnosed through a physical exam, not imaging. When pressing on specific joints reproduces a patient’s pain, it provides a much clearer answer than a scan alone. This is why people with neck and back pain that stays local, rather than traveling down the arms or legs, often have joint based pain rather than nerve compression.
Understanding whether pain is coming from discs or joints changes everything. It helps explain why MRI findings may not match symptoms and why some treatments fail while others help. Most importantly, it allows neck and back pain to be evaluated based on how the body is actually functioning, not just what shows up on imaging.
How Doctors Identify the True Source of Neck and Back Pain
According to Dr. Christopher Gleis, MD, Pain Management Specialist in Tampa, identifying the true source of neck and back pain starts long before reviewing an MRI. Imaging is only one piece of the puzzle and must be interpreted alongside a patient’s symptoms, medical history, and physical exam findings. Without that full picture, even detailed scans can point doctors in the wrong direction.
A careful physical exam is often the most important step. Dr. Gleis explained. Testing strength, movement, and joint sensitivity helps determine whether pain is coming from nerve compression, joint inflammation, or muscle guarding. Weakness, even when subtle, is one of the most reliable indicators that a specific nerve is being affected.
Symptom location also provides critical clues. Pain that travels down the arms or legs suggests nerve involvement, while pain that stays in the neck or lower back is more often related to joint irritation. This distinction helps explain why some people with significant MRI findings have little pain, while others struggle with neck and back pain despite minimal imaging changes.
Dr. Gleis emphasizes that doctors should never treat images in isolation. When physical exam findings reproduce a patient’s pain, it confirms the true pain generator far more clearly than an MRI report alone. This approach reduces guesswork and leads to more accurate, personalized decisions about care.
Why Understanding Neck and Back Pain Reduces Fear
Fear is one of the most overlooked drivers of ongoing neck and back pain. When people are told they have “degeneration,” “herniated discs,” or “damage” without clear explanation, the nervous system often shifts into a protective, high-alert state. According to Dr. Christopher Gleis, MD, this heightened state alone can amplify pain, stiffness, and muscle tension.
When patients understand where their pain is actually coming from, fear begins to drop. Clear explanations help the brain stop guessing and catastrophizing, which reduces the body’s constant protective response. As fear decreases, the nervous system becomes calmer, and the body is better able to heal and move without guarding.
Dr. Gleis emphasizes that education is not an extra step in care, it is a critical part of treatment. When patients understand why MRI findings may not match their symptoms, they are less likely to feel broken or permanently damaged. This shift alone often improves how neck and back pain is experienced day to day.
Understanding pain restores a sense of control. Instead of reacting to alarming language or unclear imaging reports, patients can make informed decisions based on how their body is functioning. For many people with chronic neck and back pain, clarity is the first step toward relief.
Why Rushing Care Can Make Neck and Back Pain Worse
Neck and back pain often worsens when care is rushed or reduced to quick conclusions. Short appointments can lead to over-reliance on MRI reports, missed physical exam findings, and treatment decisions made without fully understanding the patient. According to Dr. Christopher Gleis, MD, this is how the real source of pain is often overlooked.
When doctors do not take time to explain what is happening, fear fills the gap. Patients may assume the worst about disc findings or believe their spine is permanently damaged, even when that is not true. This fear can increase muscle tension, limit movement, and keep the nervous system in a constant protective state, all of which can intensify neck and back pain.
Dr. Gleis emphasizes that careful evaluation cannot be rushed. Understanding symptom patterns, testing strength, and examining joints requires time and attention. Without that process, treatment may focus on what is easiest to see rather than what is actually causing pain.
Slowing down care improves outcomes. When patients feel heard, understand their condition, and are not pushed into decisions, the body responds differently. For many people with neck and back pain, taking time is not a delay in healing, it is what makes healing possible.
A Better Way to Think About Neck and Back Pain
A better way to think about neck and back pain starts with understanding that pain is not just a structural problem. It is influenced by the spine, joints, muscles, inflammation, and the nervous system working together. As Dr. Christopher Gleis, MD, explains, meaningful neck and back care begins by understanding how these systems interact, not by focusing on a single image or diagnosis.
Neck and back pain should be evaluated based on how symptoms affect daily life, movement, and function. MRI findings provide helpful information, but they are only one piece of a much larger picture. When pain is assessed through thoughtful conversation and careful examination, decisions become clearer and less driven by fear.
Dr. Gleis emphasizes that all his neck and back pain patients in Tampa deserve time, education, and transparency. When people understand their pain, they feel more in control and less overwhelmed by alarming terms or unclear imaging reports. This shift alone can change how pain is experienced and how recovery unfolds.
Ultimately, a better approach to neck and back pain is one rooted in clarity rather than urgency. It respects the individual, prioritizes understanding, and avoids rushing people into decisions they do not fully understand. For many patients, this mindset is the beginning of real progress.
Disclaimer: This content is for informational purposes only and does not constitute medical advice. Please consult with a licensed healthcare provider. Genesis Brain Institute is a Brain Treatment Center in Tampa offering non-pharmaceutical solutions that bring clarity, restore function, and offer real hope for those who feel lost, stuck, or simply want more from life.
