Your Scans Came Back Normal, So Why Does It Still Hurt?
WRITTEN BY DR RUSSELL JENSEN Principal Chiropractor
Southside Spine and Sport, Bicton WA
Practising chiropractor since 2015.
Trained in Integrative Diagnosis (USA).
Special interest in nerve entrapment conditions including cluneal nerve pain, sciatica, and piriformis syndrome.
Full profile: southsidespinesport.com.au/meet-our-chiro
If you have been told your MRI or X-ray is normal, or shows nothing significant, but the pain in your lower back, hip, or glute has not gone anywhere, you have probably felt a particular kind of frustration. It is the kind of frustration that is followed by a quiet worry that, maybe, the pain is in your head.
It is not in your head. A normal scan does not mean nothing is wrong. It means the specific things a scan can detect, fractures, disc herniations, or tumours, are not present. There is a long list of common pain sources that scans don’t pick up, and in my clinic, this is one of the most common stories I hear.
Why a normal scan doesn't rule out real pain
MRI and X-ray are excellent at one job: showing bones, discs, and major structural damage. What they are not good at is showing soft tissue irritation, nerve entrapment, or the kind of muscular and fascial tension that causes a large share of chronic back and hip pain.
There is also a less intuitive problem. Structural abnormalities on a scan often have nothing to do with someone's pain. Disc bulges and degeneration show up constantly in people who have zero symptoms.
A 2015 systematic review of imaging in people with no back pain at all found disc bulges in roughly 30 percent of people in their twenties, rising to around 84 percent by their eighties, in people who had never had a symptom. A finding on a scan and the actual source of your pain are not always the same thing.
So when a radiologist reports your scan as unremarkable, it genuinely may be. The cause of your pain might simply be something imaging cannot capture, because it is about how tissues are functioning and reacting, not what they look like when you are lying still in a scanner.
This is exactly why a clinical examination matters as much as imaging. Pain that flares with specific movements, sitting, or pressure on a specific spot tells a practitioner something an MRI never will.
The conditions that often hide from imaging
A few of the most common culprits I see in patients who have already had clear scans:
Nerve entrapment. Small sensory nerves can become irritated as they pass through tunnels in tissues. The cluneal nerves, which cross the top of the pelvis, are a classic example. They do not show up on standard imaging, yet they can produce sharp, burning, or grabbing pain in the lower back, hip, and glute that closely mimics other conditions. I have written a detailed breakdown of how cluneal nerve pain presents and why it is so often missed (Cluneal Nerve Article) if that pattern sounds familiar.
Sacroiliac joint dysfunction. The SIJ can become a genuine pain generator through altered movement and loading, without any structural damage visible on a scan.
Myofascial and muscular tension. Chronic tightness, trigger points, and fascial problems are all ‘functional problems’. They cause real pain and respond well to treatment or rehabilitation, but they are invisible to MRI.
Piriformis syndrome. Compression of the sciatic nerve by the piriformis muscle is a soft tissue issue, not a structural one, so imaging typically looks clean even when symptoms are significant. Read more on our piriformis syndrome page.
Disc-related and deep gluteal syndrome type sciatica. Nerve pain travelling into the leg can originate from the spine or from the deep gluteal space, and neither always shows clearly on imaging in a way that explains the pain pattern. Read more on our sciatica page and nerve pain page.
Does this sound like you?
This is not a clinical diagnosis, but if several of these apply, the cause of your pain is very likely one that imaging was never going to catch.
Your MRI or X-ray was reported as normal, unremarkable, or showing nothing significant
The pain has continued well beyond a normal healing window (~3 months) with no clear explanation.
You can point to a specific spot that reproduces the pain when pressed
The pain changes noticeably with certain movements, positions, or amounts of sitting
You were told there is nothing structurally wrong and given no further plan or pathway
You have wondered whether the pain is in your head, despite it feeling very real.
Ticking several of these is a strong sign that a clinical, hands-on assessment, rather than another scan, is the right next step.
When imaging still matters
A normal scan is reassuring for ruling out serious structural pathology, but it does not override the need to diagnose genuine red flags. Seek prompt medical assessment regardless of any previous scan result if you experience loss of bladder or bowel control, numbness in the groin or inner thigh, progressive weakness in a leg or foot, unexplained weight loss alongside the pain, or pain that began after significant trauma. These warrant medical attention even with a clear scan.
What this means for your diagnosis
If imaging cannot identify these problems, how does anyone get a real answer? Through a thorough clinical assessment: a detailed history of when and how the pain behaves, specific palpation to find exactly where the pain originates, and tests that reproduce the pain through movement and pressure. This is slower than reading a scan, but it is how symptoms from conditions like nerve entrapment actually get resolved.
In my experience, with patients who we successfully have helped, have had the most frustrating journeys, have been told their scans are normal and then left without any further direction. The next step needed to be a proper clinical work-up.
If your scans are clear and the pain is still real, the next step is a hands-on assessment specifically looking for the things imaging cannot show. We see this pattern often enough that we do not treat it as a mystery.
Book an assessment online or call us: 08 6317 9897
What to do next
If you are sitting with a normal scan and ongoing pain, the most useful thing you can do is get a clinical assessment focused specifically on movement, palpation, and pain reproduction, rather than more imaging. At Southside Spine and Sport in Bicton, this is the approach we take with every patient who arrives in this position. We see this often enough that it doesn't read to us as a mystery, just the next logical step in finding the right diagnosis.
If the underlying driver turns out to be something we are well placed to treat, we use targeted soft tissue therapy, adhesion release , and where appropriate, shockwave therapy aimed directly at the structure involved, not just the general area.
Frequently asked questions
Can you have real pain with a completely normal MRI?
Yes. MRI is designed to detect structural problems like fractures, disc herniations, and tumours, including the kind of nerve compression that happens when a disc presses on a nerve root. What it is not designed to detect is nerve compression and irritation that happens away from the spine, in muscle or connective tissue, such as the cluneal nerves at the pelvis, the sciatic nerve under the piriformis, or the spinal accessory nerve in the neck. These are common causes of real pain that can look completely normal on a scan
Why does my doctor say there's nothing wrong if I'm still in pain?
A normal report usually means no serious structural pathology was found, which is good news for ruling out dangerous causes of pain. It does not mean there is no physical cause for your symptoms. Many common causes of persistent pain are simply not visible on standard imaging.
What can find a problem that an MRI misses?
A clinical assessment that includes movement testing, palpation of specific structures, and reproduction of the pain pattern can identify issues such as nerve entrapment, sacroiliac joint dysfunction, or myofascial restriction that imaging does not reliably detect.
Should I get a second scan if my pain hasn't improved?
Usually not. If your first scan was thorough and showed no red flag findings, repeating it is unlikely to reveal anything new. The more useful next step is a thorough clinical examination, which can determine whether further imaging is actually warranted rather than defaulting straight to another scan. In some cases, having a radiologist review the existing images again is more valuable than ordering new ones.
We're based in Bicton and see patients from across Perth's southern suburbs, including Fremantle, Melville, East Fremantle, and Cockburn.
Or call us on 08 6317 9897 if you would prefer to talk first.
Written by Dr Russell Jensen, Principal Chiropractor (AHPRA: CHI0001927257), Southside Spine and Sport. Published June 2026.
This article is for general information only and does not constitute medical advice. Always consult a qualified health professional for diagnosis and treatment.
Clinical reference: Brinjikji W, Luetmer PH, Comstock B, et al. "Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations." American Journal of Neuroradiology, 2015;36(4):811-816. View at PubMed: pubmed.ncbi.nlm.nih.gov/25430861
