Do You Really Need a Scan for That Pain?

When you’ve got ongoing shoulder pain, back pain, or knee stiffness, it’s natural to wonder: “Should I get a scan?”

Scans are useful tools—but they’re only part of the picture. Research shows that what appears on imaging doesn’t always match the level of pain you feel. Some people with “severe” osteoarthritis changes have very little pain, while others with “mild” findings may struggle day-to-day.

That’s why its usual to start with your case history and examination before deciding if a scan is helpful. Imaging is best when combined with hands-on assessment, not usually used in isolation.

The Four Common Imaging Tools:

1) X-Ray

Best for: Bones, fractures, dislocations, and moderate to severe osteoarthritis.

Not so good for: Muscles, tendons, ligaments, cartilage (these don’t show up well).

Insight -  Many people in their 40s+ will show some wear and tear (OA) on X-rays—even if they have no pain. It’s often a normal part of ageing.

2) MRI (Magnetic Resonance Imaging)

Best for: Soft tissues—muscles, tendons, ligaments, discs, cartilage. Great for sports injuries or when nerve involvement is suspected.

Insight: MRIs often show “degenerative changes” or “tears” that may not actually be painful. For example, degenerative meniscal tears in knees often respond well to rehab and hands-on treatment, without surgery.

3) CT Scan (Computed Tomography)

Best for: Detailed 3D pictures of bone—useful after trauma, fractures, or surgical planning.

Not so good for: Muscles, tendons, or ligaments compared to MRI.

Insight: More radiation than an X-ray, so usually used when a clearer bone picture is essential.

4) Ultrasound

Best for: Tendon injuries, rotator cuff tears, bursitis, guided injections. Also allows dynamic assessment—watching a tendon move as you move.

Not so good for: Deep structures like hips or spine.

Insight: It’s quick, safe, and often the first step for tendon pain.

Why Imaging Isn’t the Full Story

1. Pain doesn’t equal scan results: The “worst” scan doesn’t always mean the worst pain. Osteoarthritis on X-ray is often present in people without symptoms.

2. Incidental findings are common: MRIs frequently reveal bulging discs, cartilage fraying, or tendon tears that might not be the cause of your pain. They can be “background noise” rather than the main problem.

3. Case history + exam come first: Assessing your movement, strength, posture, and lifestyle before deciding if a scan is necessary.

4. Rehab usually comes before surgery: For many degenerative findings (like meniscal tears or rotator cuff changes), exercise, rehab, and hands-on care are the first line of management.

Surgery is considered when these approaches don’t help.

How our Chiropractors, Osteopaths & Massage in Maidstone fit in with the above information, listening to your story and how pain affects your daily life...

Examining posture, movement, strength, and joint function.

Treating with a mix of manual therapy (mobilisation, manipulation, massage), exercise rehab, and lifestyle advice.

Referring for imaging if there are no improvements with conservative care or something doesn’t add up, or if red flags suggest it’s needed. 

The goal isn’t just to “chase the scan picture” but to treat the person in front of us.

Take-Home Messages

Scans are tools, not answers.

What’s on imaging doesn’t always explain your pain.

OA changes can start in your 40s; even if you feel fine.

Many degenerative tears and changes can be managed with rehab & hands-on care, not surgery.

The best care blends your case history, exam, treatment, and (when needed) imaging.

If you think you may need an image then please discuss it with one of our Chiropractors, Osteopaths or massage therapists. We have the referral tools here in Maidstone to refer for MRI's, Xray's and CT scan  to KIMS Maidstone private hospital and Ultrasounds, just a few minutes outside Maidstone town centre.

By James Burgess (Chiropractor).