"My Spine Is Crumbling." The Scan That Caused More Fear Than the Pain Did.
Topic: Understanding MRI findings, arthritis, wear and tear, degenerative changes and why scans don't always explain pain.
This story is inspired by the many people we've cared for over the years. Names and details have been changed and combined to protect privacy. If you recognise yourself in this story, you're certainly not alone.
Margaret’s story
Margaret had always been independent. She loved looking after her grandchildren, she walked her dog every morning and she'd spend weekends in the garden, usually coming inside with muddy boots and aching knees. She accepted the odd ache as part of getting older until her back started hurting more often.
After a few months, she thought she should be proactive about her back pain and arranged to see her GP who ordered a scan for her. She wasn't particularly worried and thought it might tell her why her back hurt.
Instead, it made her feel scared.
She had a look at the report which said:
"Degenerative disc disease."
"Facet joint osteoarthritis."
"Disc degeneration."
"Loss of disc height."
She didn't understand most of the words.
But one thing became crystal clear in her mind.
"My spine is falling apart."
Over the following weeks, she stopped bending down, stopped gardening, asked her grandson to carry the shopping and she even avoided picking up her youngest granddaughter.
Not because she couldn't, but because she was frightened she would make it worse.
Seeing us at Evolv
Margaret almost cancelled her appointment. A close friend had recommended us after we'd helped her recover from her own back pain, but Margaret wasn't convinced anyone could help. In her mind, the scan had already given her the answer, "My spine is crumbling."
She worried we'd be too rough. She imagined that any treatment would make things worse. She even admitted she was frightened that someone might "break" her. More than anything, she wanted someone to tell her whether she was making the right decision by being there.
So before we examined her back, we sat down and listened. We talked about how her pain had started, what her scan report had said, what she'd stopped doing and, most importantly what she was frightened of.
Only once we understood her story did we begin the physical examination. Margaret moved cautiously and every bend forward or twist was hesitant. But as the assessment went on, something interesting happened. Her back wasn't behaving like the fragile spine she'd imagined.
When we sat down after Margaret's examination, we started by talking about her scan. Margaret told us she'd spent hours searching the internet, trying to understand words like degeneration, arthritis and wear and tear. The more she read, the more convinced she became that her spine was slowly falling apart.
It's completely understandable. Medical reports are written using clinical language. They're designed to describe what can be seen on a scan, not necessarily to explain what those findings mean for everyday life. Sometimes there simply isn't enough time during appointments to unpack every word, answer every question or reassure someone about what those findings do and don't mean.
That's where fear can quietly creep in.
So we went through the report together. We explained that changes such as disc degeneration, arthritis and wear and tear are incredibly common as we get older. In fact, research has shown that many people who have these changes on a scan have no back pain at all.
The scan wasn't telling Margaret that her spine was weak, she should stop gardening, she should never bend down again or her spine was crumbling. It was describing changes that many of us develop as we age, much like wrinkles appear on our skin or grey hairs appear over time.
That's when we could reassure her that her back was far more capable than she'd been led to believe.
So why do some people have pain with arthritis and others don’t?
Pain is more complex than we once thought. Arthritis is one piece of the puzzle, but it isn't the whole picture.
Imagine two people who both have similar changes on an X ray. One person walks five miles every morning, enjoys gardening and hardly thinks about their joints. The other struggles to get out of a chair and feels pain every day.
How can that be?
Because pain is created by your nervous system, which is constantly weighing up information from your body and deciding how much protection you need. The changes we see on an X-ray or MRI can certainly contribute to pain. Inflamed joints, irritated tissues and reduced movement can all play a part. But they're only one part of a much bigger story.
Things like poor sleep, stress, previous injuries, physical activity, muscle strength, confidence in movement, general health and even how safe your brain feels all influence how much pain you experience.
That's why two people with very similar scans can have completely different experiences.
It's also why we don't treat scans. We treat people.
Next steps for Margaret
The assessment showed that Margaret's back was much stronger and more capable than she'd believed.
Her pain was real but the story she'd been telling herself about her spine wasn't. For the first time since reading her scan report, she stopped seeing her body as something that needed protecting from every movement. Instead, she began to see it as something she could trust again.
That conversation changed everything because she stopped seeing herself as fragile. Together, we worked on helping her move with confidence again.
She gradually returned to walking the dog, gardening and playing with the grandchildren. She learned that movement wasn't damaging her spine it was helping it. The more confidence she gained, the more capable she felt.
