Imaging tests like X‑rays, MRIs, and CT scans are powerful tools, but they do not always tell the full story—especially when it comes to neck, back, shoulder, and other sports‑related injuries. Even when an imaging report says “normal” or “no significant findings,” you can still have real pain, stiffness, and movement problems that interfere with daily life and athletic performance.
When “Normal” Imaging Doesn’t Match How You Feel
Standard imaging is excellent at showing anatomy, but pain and function are not determined by anatomy alone. Strength, movement, load tolerance, irritability, and the nervous system’s response to pain can all matter without being fully captured on the scan.
That is why an MRI report and a clinical examination answer different questions. They are most useful when they are interpreted together.
Imaging is a snapshot, not a complete movie of how your body functions. Pain can come from subtle issues like muscle guarding, poor spinal stability, or small movement faults repeated thousands of times. These functional problems are often best found and treated through a skilled physical examination and movement assessment, not by ordering more and more scans.
What MRIs Often Miss: Multifidus Atrophy, Fatty Infiltration, and Chronic Low Back Pain
One of the most clinically important findings that frequently gets overlooked on a lumbar MRI report is the condition of the multifidus muscles—the small, deep stabilizers that run along each side of your spine. Even when a radiologist’s report flags only the discs, joints, or nerves, the multifidus may show atrophy (shrinkage), fatty infiltration (healthy muscle replaced by fat), or reduced cross‑sectional area—changes that rarely appear in the impression line of a standard radiology report.
A growing body of peer‑reviewed research has linked these multifidus changes to chronic and recurrent low back pain. Specifically, multifidus atrophy and fatty infiltration correlate with:
- Pain duration—the longer the pain, the greater the muscle change
- Disability scores on validated outcome measures
- Leg pain intensity in patients with referred or radicular symptoms
- Spinal degenerative findings including disc degeneration, Modic endplate changes, facet joint arthrosis, and disc herniations
In other words, the multifidus is often where chronic back pain “lives”—even when the rest of the MRI looks unremarkable, or even when degenerative findings are present but do not fully explain your symptoms. Multifidus dysfunction is not the sole cause of every back pain case, but addressing it is a cornerstone of nearly every evidence‑based rehabilitation program for chronic low back pain.
This is where specific rehabilitation matters. Generic stretching and generalized “core” exercises do not selectively recruit the multifidus. Dr. Cancel uses targeted activation and progressive loading—the kind of work used in athletic rehabilitation—to rebuild multifidus function, strength, and motor control. For some patients, that is an important part of breaking a cycle of recurrent pain.
Dr. Douglas Cancel: Beyond the Picture on the Screen
Dr. Douglas Cancel of Performance Sport Care in Walnut Creek, CA, is a sports chiropractor who specializes in helping people with neck pain, back pain, shoulder injuries, and other musculoskeletal conditions. Rather than relying only on an imaging study to the exclusion of other findings, Dr. Cancel focuses on how you move, how you feel, and how your body is likely to respond to a precise treatment and targeted exercise plan.
He combines:
- Manual therapy to restore joint motion, reduce muscle tension, and improve soft tissue quality
- Supervised strength training to build real‑world stability and resilience
- Nutritional guidance to support tissue healing, recovery, and overall performance
This integrated approach allows Dr. Cancel to address contributors to pain and dysfunction that imaging alone does not describe.
The Unique Benefits of Dr. Cancel’s Therapeutic Services
1. Manual Therapy That Finds What Imaging Can’t
X‑rays and MRIs can show structure, but they cannot feel where a joint is stuck, where a muscle is overly tight, or how tissues respond to specific positions and loads. Dr. Cancel’s manual therapy helps to:
- Improve spinal and extremity joint mobility
- Release tight or overworked muscles and fascia
- Reduce local irritation and help normalize movement patterns
For many patients with neck, back, or shoulder pain, this hands‑on approach provides relief and functional improvement even when imaging results are “unremarkable.”
2. Supervised Strength Training Instead of Over‑Imaging
Too often, people with persistent pain are sent from one imaging study to another—new X‑rays, another MRI—without a real change in their care plan. Extra scans don’t strengthen weak muscles, stabilize a wobbly shoulder, or retrain poor lifting mechanics. Dr. Cancel helps patients build strength and control through supervised, progressive training, so they can:
- Safely load injured areas and progressively rebuild strength and load tolerance
- Address movement or strength deficits that are not described by the scan
- Increase capacity for the activities the patient needs to tolerate
This approach keeps the focus on function rather than repeatedly “looking” at the same structures on a screen.
3. Nutritional Guidance That Supports Structural and Functional Health
Nutrition does not explain every painful musculoskeletal problem, and it is not a substitute for diagnosis or rehabilitation. But when protein intake, overall diet quality, glucose control, or recovery habits are clearly relevant, they are reasonable parts of the larger conversation about recovery. Practical nutrition and recovery guidance, when relevant, supports:
- Muscle repair and adaptation from strength training
- Recovery from manual therapy and daily activity
- Healthier body composition, which reduces excessive load on the spine and joints
By supporting recovery and rehabilitation, the constant “search” for answers through more imaging alone becomes unnecessary.
Empowerment Without Overuse of Imaging
Imaging has an important role—especially when serious red flags are present or surgery is being considered—but more tests do not automatically mean better care. Over‑imaging can:
- Create anxiety when age‑related “findings” are labeled as disease
- Lead to unnecessary procedures that do not match your actual pain drivers
- Shift attention away from proven strategies like movement, strength, and lifestyle change
Dr. Cancel’s philosophy aligns with a more balanced, patient‑centered approach: use imaging when it will change the plan, not as a reflex. He listens to your symptoms, checks your movement, and uses imaging wisely instead of excessively.
When the Scan and the Symptoms Don’t Seem to Match
If an MRI or X-ray has not explained why you still hurt, another clinical look may be useful. At Performance Sport Care in Walnut Creek, Dr. Cancel reviews the imaging in the context of your history, examination, strength, movement, and what you are trying to get back to.
That may be worth doing if:
- Your imaging tests are “normal,” but you still have neck, back, or shoulder pain
- Your scans show “degeneration” or “disc changes,” but you want conservative, active care before considering injections or surgery
- You are an athlete or active person who wants to return to sport with a clear plan, not just an imaging report
- You prefer a strategy built on hands‑on care, strength training, and smart lifestyle changes rather than endless testing
The next step may be treatment here, additional imaging, another medical opinion, or a different direction entirely. The point is to make the next decision more useful.
Frequently Asked Questions
Why can my back still hurt when my MRI report looks normal?
A normal or reassuring MRI can make many structural explanations less likely, but no scan explains every source of pain or functional limitation. Pain can be influenced by muscles, joints, nerves, movement, load tolerance, and other factors that need to be interpreted clinically. Imaging is one part of the evaluation, not the entire evaluation.
What is multifidus atrophy, and can it improve?
The multifidus is a group of deep spinal muscles involved in segmental control and movement. Changes in multifidus size, fatty infiltration, and function have been reported in people with chronic low back pain. Targeted exercise and progressive rehabilitation can improve muscle function and, in some studies, muscle morphology. That does not mean multifidus changes are the cause of every case of back pain or that changing an MRI image is the primary goal of rehabilitation.
I have already tried chiropractic care. Why might another evaluation still be useful?
Previous treatment not helping does not tell us why. Dr. Cancel reviews what you have already tried, examines the current problem, and determines what the present findings support. Sometimes a different conservative plan makes sense. Sometimes further imaging or another specialist is more appropriate.
How does Dr. Cancel evaluate pain when imaging does not explain it?
He combines the history and imaging with an appropriate neurological, orthopedic, functional, movement, and strength examination. The purpose is not to claim that the examination can discover everything an MRI misses. It is to determine which findings appear clinically relevant and what they imply for the next step.
What if the examination still does not explain my symptoms?
That is useful information too. If the clinical picture remains unclear, symptoms are changing, or the findings suggest a problem outside the scope of care here, Dr. Cancel may recommend additional imaging, laboratory or medical evaluation, or consultation with another specialist rather than forcing a treatment diagnosis.
Should I get another MRI if my pain is not improving?
Not automatically. Repeat imaging makes sense when new or worsening findings, trauma, red flags, surgical or procedural planning, or another change in the clinical picture makes the result likely to affect management. Repeating a scan simply because pain persists is not always useful.
How is the Performance Sport Care facility relevant when imaging is normal?
When the evaluation shows that strength, movement, or load tolerance should be rebuilt, rehabilitation can be supervised in the same facility as the clinical care. That lets exercise progress from light, controlled movement to more substantial loading when the patient’s condition and goals require it.
