Why Looking Solely at Your X-Ray or MRI for Knee Pain Can Be Misleading
Why Looking Solely at Your X-Ray or MRI for Knee Pain Can Be Misleading
When people experience knee pain, it’s common to hear phrases like, “I have a torn meniscus,” or “I’m bone-on-bone,” based on their X-ray or MRI. Many patients assume that these findings mean they’re destined for surgery or that their knee condition will only worsen without invasive intervention.
However, relying solely on imaging can be misleading and often results in unnecessary surgeries or over-treatment. At Back In Motion, we see a common pattern in knee pain patients: abnormal knee movement caused by hypermobility leads to ligament, meniscus, and cartilage pain. If these movement dysfunctions are not addressed, they can progress into arthritis and chronic knee issues.
Let’s break down the science behind why imaging results don’t tell the whole story, what we commonly see in practice, and how addressing movement impairments can help resolve knee pain without surgery.
What We Commonly See: The Hypermobile Knee
At Back In Motion, many knee pain patients present with abnormal knee movement, which we call knee hypermobility. The knee moves too much relative to the hip and ankle, causing uneven stress on the ligaments, meniscus, and cartilage.
Here’s what happens:
- The hip or ankle may be too stiff or weak, forcing the knee to compensate by moving excessively.
- This extra movement causes the ligaments, meniscus, and patellar cartilage to become irritated and painful.
Over time, this abnormal movement pattern can lead to arthritic changes in the knee joint.
Example: Hyperextension and Meniscus Stress
We often see patients with hyperextension knee syndrome (HKE), where the knee extends too much before the hip during walking or running. This creates excessive stress on the meniscus and ligaments, which may show up on an MRI as a meniscus tear. However, the tear may not be the primary cause of the pain—the movement dysfunction is.
Why Imaging Findings Don’t Always Correlate with Pain
One of the biggest misconceptions is that what you see on an X-ray or MRI directly explains your pain. However, research shows that many people with abnormal imaging findings have no pain at all.
What the Science Says:
A 2018 study in The BMJ found that up to 43% of middle-aged adults with meniscus tears had no knee pain (Khan et al., 2018). Similarly, degenerative changes like arthritis are often seen in asymptomatic individuals.
What This Means:
Many patients who are told they have a meniscus tear or cartilage degeneration based on an MRI don’t need surgery. Instead, they need to address the movement dysfunction that is overloading the knee joint.
Why “Bone-on-Bone” Arthritis Is Often Misunderstood
Many patients are told they are “bone-on-bone” based on X-ray findings showing joint space narrowing. This phrase can be frightening and lead patients to believe that joint replacement surgery is inevitable.
However, research shows that joint space narrowing doesn’t always correlate with pain or disability.
What the Science Says:
A study published in The New England Journal of Medicine found that X-ray findings of osteoarthritis had little correlation with knee pain (Felson et al., 2001).
What This Means:
Even if your X-ray shows severe joint space narrowing, it doesn’t mean you’ll be in constant pain or that surgery is necessary. Addressing muscle imbalances and movement impairments can often resolve knee pain and improve joint function.
How Hypermobile Knees Lead to Pain (and Arthritis Over Time)
What Happens When the Knee Moves Too Much?
The knee joint is naturally designed to be stable, with the hip and ankle providing most of the movement during walking, running, and other activities. However, when the knee becomes hypermobile, it starts moving in ways it shouldn’t—leading to wear and tear on the ligaments, meniscus, and cartilage.
If this isn’t corrected, the extra movement can cause:
- Ligament irritation (leading to chronic knee instability)
- Meniscus tears (due to uneven stress)
- Cartilage damage (leading to patellofemoral pain syndrome)
Arthritic changes (as the joint experiences long-term stress)
Why You Should Focus on Movement, Not Just Imaging
At Back In Motion, we focus on fixing the cause of knee pain, not just treating what’s seen on an X-ray or MRI. Our assessments identify abnormal movement patterns and muscle imbalances that are causing the knee to move excessively.
We commonly see:
- Tibiofemoral rotation syndrome (where the knee twists excessively)
- Hyperextension knee syndrome (HKE) (where the knee locks out too early)
- Lack of inferior glide of the patella (where the kneecap doesn’t glide properly during movement)
By addressing these dysfunctions, we can:
- Reduce pain
- Improve joint stability
- Prevent future arthritis and joint damage
Remember, Imaging Alone Doesn’t Tell the Whole Story
While X-rays and MRIs can provide useful information, they don’t always explain your pain. The root cause of knee pain is often found in movement impairments and muscle imbalances, not in what you see on an imaging report.
At Back In Motion, we use the Gray Method™ to detect and fix these dysfunctions, helping patients avoid surgery and get back to doing what they love—pain-free.
Take the Next Step Toward Knee Pain Relief
Curious about how we can help?
- Schedule a consultation today to get a personalized movement assessment.
- Learn how to fix the root cause of your knee pain without risky treatments.
- Find out about costs and availability by reaching out to our team.
Let’s help you get back to living active and pain-free!