When to get an MRI or X-ray for muscle or joint pain
It’s easy to assume that an X-ray or MRI is the quickest way to find out what’s causing pain — but that’s not always the case. In many situations, imaging adds little to what a thorough assessment by your physiotherapist can already tell you. Understanding when a scan is helpful and when it isn’t can save time, money, and unnecessary worry.
When Do You Really Need a Scan?
X-rays, ultrasounds, CT scans, and MRIs are some of the most common medical imaging tools used to help diagnose injuries and medical conditions — especially those involving the muscles, joints, and bones. They can be incredibly valuable in confirming a diagnosis or ruling out serious issues.
But imaging also has its limitations. Some scans involve radiation exposure (like X-rays and CTs), they can be costly, and most importantly, they’re not always necessary for effective treatment.
The Key Question: Will Imaging Change Your Management?
A simple rule of thumb we use in healthcare is this: imaging should be ordered only if it’s likely to change how your condition is managed.
For many musculoskeletal problems, a skilled assessment — involving a detailed history, physical examination, and specific movement tests — often provides enough information to guide treatment confidently. In these cases, scans add little extra value and can sometimes even create confusion or concern.
If symptoms aren’t improving after a reasonable period of treatment, or if there are signs that something more complex might be going on, imaging may then be appropriate to guide the next step in care.
Understanding Your Imaging Report
These days, many patients receive their imaging reports directly on their phone before they’ve had a chance to discuss the findings with their GP or physiotherapist. It’s easy to feel alarmed when you read terms like osteophytes, meniscal tear, or tendinopathy — but these findings don’t always mean something is “wrong” or needs fixing.
A study by Culvenor et al. (2019) found that MRI scans showed signs of knee osteoarthritis in people with no symptoms or injury at all — between 4–14% of adults under 40, and 19–43% of adults over 40. In other words, changes on imaging can be a normal part of ageing and may not relate to your current pain.
This principle applies to other joints too — it’s not unusual for shoulder, spine, or hip scans to show “abnormalities” that don’t actually cause pain or limit function.
Putting It All in Context
At Manning Physio, we interpret imaging results in the context of your symptoms, movement, and function — not just the scan report. Our goal is always to understand what’s truly driving your pain and tailor your treatment accordingly.
So if you’ve received a scan report that sounds concerning, try not to panic. Book in to discuss it with your physiotherapist — we can help you understand what the findings mean (and don’t mean) for you, and what steps will help you get back to moving well again.
References
Culvenor, A. G., Øiestad, B. E., Hart, H. F., Stefanik, J. J., Guermazi, A., & Crossley, K. M. (2019). Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British journal of sports medicine, 53(20), 1268–1278. https://doi.org/10.1136/bjsports-2018-099257
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