Article Rundown

• MRI findings don’t equal pain — assessment determines the true pain driver
• Imaging is important, but it’s only one piece of the clinical puzzle
• Recovery requires both movement competence and psychological confidence
• Long-term healing demands patience, ego control, and individualized care

Treat the Person, Not the MRI

One of the most common debates I run into—whether it’s with clinicians, trainers, or even other strength athletes—is the role of MRI findings in back pain. People love to throw around studies showing that a large percentage of asymptomatic individuals have disc bulges, degeneration, or other “abnormalities” on imaging. And they’re not wrong. But here’s the issue: that statistic is often used in the wrong context.

Yes, there are multiple studies showing that roughly 50% of asymptomatic people have changes on MRI. That matters academically. But it has very little relevance to the population I work with every single day. The people who come to see me aren’t walking around pain-free wondering what their MRI looks like. They’re in pain. Many of them have been in pain for years. Some of them are at the end of their rope. That’s why we assess the person—not the image.

An MRI on its own doesn’t tell you where pain is coming from. It doesn’t tell you what movements provoke symptoms, which tissues are sensitive, or how stress is being distributed through the spine. That’s what a proper assessment does. We provoke pain, we take it away, and we identify the specific mechanism driving it. When the assessment and the imaging line up—when there’s a one-to-one relationship between symptoms and structure—that’s not a false positive. That’s information.

Why “False Positives” Miss the Point

The idea of MRI “false positives” gets thrown around as if it invalidates imaging altogether. That’s not only wrong—it’s unprofessional.

Imaging is necessary to rule out red flags. Cancer, cysts, fractures, serious neurological issues—these aren’t things you guess at. An MRI is part of responsible care. But it’s only part of the picture.

I’ve seen people with lumbar spines that look absolutely destroyed on imaging who have zero pain. I’ve also seen people with relatively minor disc bulges who can’t stand or walk without severe symptoms. The difference isn’t the MRI—it’s how their spine is being loaded, how their nervous system is responding, and what movements are provoking their symptoms.

That’s why we spend four hours assessing someone. We test positions. We tension nerves. We load and unload tissues. We identify which motions calm the spine down and which ones flare it up. You can’t do that in a 15-minute appointment, and you can’t do it by staring at an image. We don’t dismiss MRI findings. We contextualize them.

Why Time and Listening Matter

A lot of people who come to see me aren’t just dealing with physical pain—they’re dealing with years of not being heard.

They’ve bounced from appointment to appointment. Thirty minutes here, thirty minutes there. Different practitioner every visit. No continuity. No real assessment. No one asking how long they’ve been in pain, what they’re afraid of, or what movements actually make things worse.

Sometimes the most important part of an assessment is letting someone talk. Sometimes they need to cry for two hours because no one has ever taken the time to listen to them. That matters more than people realize.

Back pain isn’t just mechanical—it’s deeply tied to psychology, fear, and uncertainty. If you don’t address that, you’ll never fully solve the problem.

The Psychological Side of Getting Back Under the Bar

Coming back from injury isn’t just about rehab exercises. It’s about mindset. For me, lifting heavy weights was my identity. That didn’t change after I got hurt—but how I applied that mindset did. I treated my rehab the same way I treated meet prep. Walking, movement, exercises, nutrition—everything mattered. The intensity was different. The volume was different. But the focus was the same.

That said, my mindset isn’t the average person’s mindset. And that’s important. Not everyone is a competitive lifter. Not everyone is a soldier. Not everyone thrives on pressure. Part of my job is figuring out who’s in front of me and adapting my approach. Some people need confidence. Some need reassurance. Some need to slow down. Others need to be pushed—carefully.

Fear isn’t the enemy. Fear is normal. Every time I stepped under a heavy bar, I felt fear. The difference is whether fear controls you or informs you. Healthy fear keeps you sharp. It doesn’t paralyze you.

Rebuilding Confidence Through Movement

Most people don’t need to become elite athletes again. They just want their life back. They want to get off the toilet without pain. They want to stand up from a chair without a stab in their back. They want to move without throwing themselves into a spasm. And often, they don’t understand why their pain keeps happening.

That’s where movement competence comes in. If someone has a disc herniation and bends through the same painful segment every time they sit or stand, they’re going to keep provoking symptoms. My job is to teach them how to move differently—how to hinge properly, how to spare the spine, and how to rebuild confidence in motion.

When people understand what’s happening and why, fear drops. When fear drops, movement improves. When movement improves, pain often follows.

Ego, Identity, and Long-Term Resilience

One of the biggest obstacles to recovery is ego. For some people, lifting—or their injury—becomes their entire identity. They can’t step away. They can’t adapt. They can’t put the ego aside long enough to heal. And that’s where things spiral.

You have to be more than your injury. You have to be more than your numbers in the gym. That doesn’t mean giving up—it means playing the long game.

I tried to fix my own back for years before I finally did the right thing. I stopped chasing short-term fixes. I stopped bending and twisting through pain. I let my spine calm down. I rebuilt resilience the right way.

And on the other side of that? I squatted over 1,300 pounds. Pain-free. More than a decade later. That isn’t luck. That’s patience, assessment, and humility.

Final Thoughts

Back pain affects almost everyone at some point in their life. Some people never recover—not because they can’t, but because they never get the right help, the right assessment, or the right mindset.

There’s no single answer. No magic exercise. No MRI that tells the whole story. But if you treat the person, take the time to assess properly, and rebuild movement confidence step by step, recovery is possible—at every level.

BRIAN DOES ONLINE AND IN-PERSON COACHING!

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