"But everything looks normal."

You’ve heard it before: “Your MRI looks fine.”
But if the scan is normal, why are you still in pain?

In this episode of Talking Rehab, Dr. Fred Bagares unpacks why imaging often fails to tell the whole story, the four critical gaps in musculoskeletal care, and how to find real answers when “normal” results don’t match your lived experience. Through the story of a nurse carrying two years of “normal” test results and daily pain, you’ll discover a better framework for navigating your recovery — one built on answers, personalization, trust, and long-term coaching.

Timestamps

[00:00] The problem with “everything looks normal”
[01:00] Imaging shows structure, not function — why that matters
[02:30] Patient story: A nurse’s two-year journey of normal results and daily pain
[04:00] The 4 critical gaps in musculoskeletal care
 • Gap 1: Structure vs. function
 • Gap 2: The time trap
 • Gap 3: The single-visit solution
 • Gap 4: The cookie-cutter approach
[07:00] Building a real partnership: personalized care and long-term guidance
[09:00] The 4 Pillars of Comprehensive MSK Care
 1. Answers when imaging isn’t enough
 2. Personalized treatment protocols
 3. Long-term physician relationships
 4. Guidance as your rehab coach
[12:00] How to ask better questions and demand better answers
[13:00] Closing reflection: You’re more than a set of images

Transcript

0:00

Your MRI looks great. Everything appears normal For someone your age, many of you have heard those words. Maybe you felt relief for about 30 seconds. Then reality hit if everything looks normal. Then why does your shoulder still feel like it's on fire every morning? Why does your back sees up after sitting at your desk? Why does your knee buckle when you're just walking down the stairs? Here's what nobody tells you about those normal results. Today I want to pull back the curtain on something I see every single day in my practice. Patients who've been told their imaging is fine, but their lives are anything. But we're going to explore why this happens, what's really going on, and most importantly, how to get the answers you actually need. Quick favor, before we dive in. If this podcast has changed how you think about your body or your recovery, hit that subscribe button. It's free. It takes two seconds, and it's how we keep bringing you these conversations every week. No fluff. Just real talk about what actually works. Thanks for being here. Now let's get into it. here's the truth, when imaging isn't enough, that doesn't mean you're out of options. It means you need someone willing to dig deeper. We live in an age of imaging. MRI, CAT scan, ultrasound. We can see inside the body with incredible detail, and somewhere along the way we started believing that if we can see it, we can fix it. If we can't see it, it must not be real. But here's what. 10 years of practice has taught me imaging shows structure, not the actual function. It shows what things look like, not how they actually work together. It's like looking at a photograph of an orchestra and trying to determine if they're playing in harmony. You can have a quote unquote perfect MRI and still have significant functional problems, or you can have findings on your scan that have absolutely nothing to do with your pain. Even though the image may be the truth, It may not actually match what you're living through every single day. Let me tell you about a 38-year-old nurse who came to see me after what she called the most frustrating two years of her life. It started with lower back pain during our shifts. The pain was sharp, unpredictable, and radiated down her left leg. Her primary care doctor ordered an MRI. They said they saw some disc bulging, but nothing that should be causing significant symptoms. Physical therapy helped temporarily. The exercises felt good in the clinic, but the pain always returned. The next stop, pain management. An epidural injection provided six weeks relief. Then it was back. Eventually she was referred to see orthopedics where they reviewed the same MRI and they concluded that the disc bulge was minor and maybe to try more physical therapy. Not really satisfied with that answer. She. Asked to be seen by another specialist for another opinion. She was sent to rheumatology, tested for inflammatory conditions, and again, everything came back normal. She was then referred to neurology where they did an EMG study, and again, nothing was definitive. Everything looked normal. By the time she reached my office, she was carrying a folder of normal test results, but walking with a visible limp. She had reduced her shifts, was taking daily pain medication, and had to start to wonder if this was just her new reality. Dr. Begar, she said, everyone keeps telling me the pictures look fine, but I'm not fine. What am I missing? that's when I realized the patient didn't just need another doctor. She needed someone willing to go beyond what the pictures actually showed. Why does this happen? Why do well-trained physicians sometimes miss what's really actually affecting you? In my opinion, it comes down to four critical gaps in how we approach musculoskeletal problems. Gap number one is the structure versus function Imaging shows anatomy, the bones, joints, discs, tendons, but pain often comes from how these structures work together, not just how they look. Think of it like this. You can have two identical cars with the same looking engines, but one runs smooth and the other one shakes violently. The problem isn't the parts it may be how they're interacting with each other. The disc bulge was real, but it wasn't the whole story. What actually mattered was how her pelvis is moving and how her core did not stabilize. It also was related to how her nervous system responded to certain positions, none of which actually shows up on any MRI. Gap. Number two, the time trap. Most physicians get maybe six to seven minutes with you. That's if you actually see the physician at your first initial evaluation, that's not enough time to review your imaging, do a thorough examination and come to a well thought out clinical decision. There's no time to understand your movement patterns. Your daily activities and your compensation strategies. But here's the thing, your body is incredibly adaptive. When something hurts, you unconsciously change how you move. Over time, these compensations become part of the problem understanding all of these factors requires time, and time is exactly what the system doesn't allow. Gap number three is the single visit solution. Healthcare is built around the idea that one visit should provide one answer. You come in with a problem, you leave with a solution next patient. But musculoskeletal problems are rarely that simple. They develop over time through complex interactions between your anatomy, activities, stress levels, sleep, and even your beliefs about pain. Unraveling that complexity requires a relationship, not just a consultation gap. Number four, the cookie cutter approach. Once you get a diagnosis, even if it's a vague one, you often get a standard protocol. Disc problems, get a McKenzie exercise, shoulder impingement, gets pendulum types, stretches, This type of knee pain gets an injection, but your body isn't standard. Your life isn't a standard. Your goals aren't a standard. So why should your treatment be standard? Back to the story, during our first meeting, I spent about 60 to 70 minutes, not six or seven minutes. To really understand what was going on in her life. We reviewed her imaging together, but then we went much deeper into the clinical history. I watched how she moved, how she sat, how she transitioned from sitting to standing. I learned about her 12 hour shifts, her sleep patterns, the stress she was carrying about potentially having to change careers. What I discovered wasn't in any of her reports. She had developed a subtle but significant compensation pattern from years of lifting patients while protecting her back, which created an imbalance in how her core muscles fired Once she started developing pain, she moved with a very guarded and rigid pattern, which creates, again, different types of tensions across joints and muscles that weren't designed to move that way. Now what about the disc bulge? It was real, but it was likely a byproduct of the initial compensation pattern, her relatively sedentary life. and other side effects of what the pain has actually cost her here's the key insight. Treating the disc without addressing the movement dysfunction was like putting a bandaid on a leak without turning off the water. The treatment wasn't a generic protocol. It was built specifically around her work demands, her movement patterns and her goals. More importantly, I had to make sure that she was going to work with a physical therapist that matched her particular style. just like any other person. Finding the right physical therapist to match her personality was a key to a successful rehabilitation program. Her rehabilitation program did evolve as she progressed, adapting to her changing needs. Most importantly, it wasn't a one and done solution. I made sure to see her back. We built a partnership. I became her physician ally for the long term, someone who understood her history and could guide her through not just this one particular episode, but whatever came next. Within three months, she was back to working full shifts without any pain, but more than that, she understood her body in a way that she had never before. She had tools, she had strategies, and more importantly, she had ongoing support. One of the biggest fears I find with this type of patient is that they are always concerned about what to do if the symptoms come back. Aside from her education and learning how to use all the tools, she always knew she could call me or text me if she needed someone to help give her a little bit more guidance. Her story illustrates what I call the four pillars of a comprehensive musculoskeletal care program, and I'm gonna share that with you so that when you. Have any future problems and need musculoskeletal care. You have the ability to know whether or not the person sitting across the desk from you has the right mindset and skill. To help you with your problem. When your MRI is quote unquote normal, but you don't feel that way, you have to find someone that is willing to dig deeper, someone to look at your movement patterns, your functional tests, view you as a whole system working together. You deserve an explanation that actually makes sense to your experience. Pillar number two, finding someone that. Is going to approach you with a personalized treatment plan. There should not be a cookie cutter exercise sheet or a generic injection protocol. Your treatment plan is built around your specific condition, lifestyle and goal. More importantly, your rehabilitation program has to adapt as you heal and grow. Pillar number three, developing a long-term relationship. True healing happens over time through trust and continuity. Instead of bouncing between different doctors at every visit or seeing one of their partners. You have to have someone that knows your history and walks with you through each chapter. Pillar number four, you need a rehab coach. Recovery can be very long and confusing. There are so many options, so many opinions. You need someone who combines medical expertise with clarity and the ability to coach you, not just treat the pain, but to also help you rebuild your confidence and momentum. If you're listening to this and recognizing your own story, if you've been told your imaging is normal, but your life isn't, here's what you need to know. Your experience is valid. Just because a test doesn't show the problem clearly, doesn't mean the problem isn't real. Your body is telling you something important. Normal doesn't mean optimal. Your MRI might look quote unquote fine for your age, but that doesn't mean it's the best your body can feel or function. You also deserve better answers. It's not just wear and tear or take some ibuprofen. It's just simply not good enough when pain is affecting your sleep, your work, and ultimately your life. So here's how to get those better answers. You have to get comfortable asking the deeper questions. Don't just accept imaging looks normal. Ask if the imaging is normal. What else could be causing my symptoms? How do we figure out what's really going on? You also have to demand to have a more comprehensive valuation look for providers who offer extended consultation times. Real detective work takes time. Six to seven minutes is simply not enough. You need someone that is going to take the time to understand complex problems. You should seek out personalized solutions if your treatment plan looks identical to what everyone else with your diagnosis gets, it's probably not personalized enough. Your plan should reflect your specific situation and goals. Lastly, look for partnerships, not transactions. Rehabilitation works best as a relationship, not a series of isolated visits. Find providers who are invested in your long-term success, not just getting you out of their office. In closing, your pain has a story. Your movement has patterns. Your body has experience that no machine can capture. But finding that story, understanding those patterns, listening to that experience requires a different approach. It requires someone willing to spend time with you to see you as a whole person rather than a collection of symptoms. If you're feeling stuck right now, don't give up. The answers do exist. Sometimes they just require looking through a different lens, asking different questions or finding someone with the time and the tools to really understand what's going on. Thanks for joining me today on The Talking Rehab Podcast. If this episode resonates with you, share it with someone who might be looking for somebody to help them through this part of their journey. And if you're ready to go beyond the pictures and get real answers, I've put together some resources that might help you. At fred garris.com you'll find guides for preparing more productive consultations. Decision trees for when imaging doesn't match your symptoms and tools to help you find providers who offer comprehensive evaluations. Until next time, keep seeking real answers. Advocating for comprehensive care, and remember, you're not just a set of images. Thanks again for listening. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.