Often when a patient experienced joint or spine pain, an Xray is ordered that shows “osteoarthritis” or “degenerative joint disease”. The physician often points to these findings as the cause of the pain. Not surprisingly, XR findings often do not correlate with pain. The Xray changes take years to develop and usually have been present long before the pain appears. Degenerative changes of joints occur in all of us as time progresses, but do not necessarily produce pain. I have seen patients with severe Xray changes, including bone on bone that are functioning well without significant pain. I have also seen many patients in severe pain that have normal Xrays and even MRI scans.
Finding and treating the cause of musculoskeletal pain involves evaluation of mechanical factors including injury, sudden increase of or change in activity, evaluation of the kinetic chain- for example, poor foot mechanic such as overpronation may produce not only foot pain, but also knee, hip, pelvis, and back pain. Imaging can be helpful, but a careful history and physical examination are the most likely to elucidate the cause and point to the treatment solution. Beware of providers that rely primarily on imaging for diagnosing, especially if they have few questions and cursory examination that does not include adjacent structures. We like to evaluate from waist to foot for lower problems and from head/neck to hands and upper back for upper problems.