The MRI Era: How ESPN Helped Create a Nation Obsessed with Imaging
Turn on almost any professional sporting event.
A player grabs their knee.
Another clutches their shoulder.
Someone lands awkwardly and limps off the field.
Within minutes, the announcer says it.
"He's scheduled for an MRI tomorrow."
You've heard it hundreds of times.
Maybe thousands.
And after thirty years of sports coverage, millions of Americans have unconsciously learned an interesting lesson:
If it's a real injury, you get an MRI.
Not because ESPN intended to teach medicine.
But because repetition teaches us things whether we realize it or not.
Over time, advanced imaging stopped being one diagnostic tool among many.
It became the diagnostic tool in the public's mind.
Before MRI, Clinicians Actually Had to Examine Patients
This may sound strange to younger clinicians and patients, but there was a time when physicians diagnosed most musculoskeletal injuries without an MRI.
They listened.
They watched people move.
They asked questions.
They performed physical examinations.
They followed patients over time.
Some of the orthopedic tests we still use today were developed decades before MRI existed.
Were they perfect?
Not even close.
But experienced clinicians became remarkably good at recognizing common injury patterns through history and examination alone.
MRI didn't replace good clinical reasoning.
It was invented to complement it.
Then Sports Television Changed Everything
Professional sports have always embraced cutting-edge medicine.
An MRI is quick.
It provides detailed images.
Teams have millions of dollars invested in athletes, so obtaining advanced imaging often makes perfect sense.
The problem is what happened outside professional sports.
For decades, television viewers repeatedly heard the same sequence:
Player gets hurt.
Player leaves the game.
Player gets an MRI.
Diagnosis follows.
Eventually, many people began assuming that this is simply how medicine works.
The physical examination became almost invisible.
The MRI became the star of the show.
Again, this isn't ESPN's fault.
Sports broadcasting wasn't trying to educate viewers about musculoskeletal medicine.
But it unintentionally helped shape public expectations.
The MRI Promise
Patients rarely ask for an MRI because they love technology.
They ask for one because they believe it promises three things:
A diagnosis.
A prognosis.
A solution.
And who can blame them?
When you're in pain, uncertainty is often worse than the pain itself.
You want someone to tell you exactly what's wrong.
Exactly how long it'll take to heal.
Exactly what you should do next.
MRI feels like it should provide those answers.
Sometimes it does.
Often, it doesn't.
An MRI may identify damaged tissue.
It may identify completely normal aging.
What it usually can't tell you is whether that's actually causing your pain.
It can't predict exactly when you'll recover.
It can't tell you whether you'll respond to exercise, injections, surgery, or simply time.
Patients don't really want an MRI.
They want certainty.
MRI is an incredible diagnostic tool.
But it was never designed to eliminate uncertainty.
That's still where clinical reasoning comes in.
The MRI Became the Diagnosis
As the saying goes, “if I had a dollar every time I’ve heard a patient say.”
"My doctor hasn't ordered an MRI yet."
"Don't you think I need one?"
"How can we know what's wrong without imaging?"
“I want to make sure we’re not doing any further damage.”
These questions rarely come from bad intentions.
They come from years of cultural conditioning.
I sometimes want to yell at a patient, “you’re not a multimillion dollar athlete, give it some time and see what happens!”
Many patients now feel that skipping an MRI means their injury isn't being taken seriously.
The truth is, many diagnoses can be made with a thorough history and physical examination before anyone ever steps into an MRI scanner.
More Pictures Don't Always Mean Better Care
MRI is one of the greatest technological advances in modern medicine.
It can identify ligament tears, tendon injuries, bone marrow edema, tumors, infections, spinal cord pathology, occult fractures, and countless other conditions.
The problem isn't MRI.
The problem is using MRI when it doesn't change treatment.
Research has repeatedly shown that early imaging for uncomplicated low back pain generally does not improve pain, function, or long-term outcomes. Instead, it often increases healthcare costs, additional testing, injections, and surgery without improving recovery (Chou et al., 2009; Qaseem et al., 2017).
The same concept applies to many shoulder and knee conditions.
Many people without pain have:
Rotator cuff tears
Meniscus tears
Labral tears
Disc bulges
Cartilage defects
Tendon degeneration
These findings become more common with age.
An MRI often reveals normal aging just as readily as it reveals injury.
Sometimes the image explains the symptoms.
Many times it's simply an expensive photograph of a perfectly functional body.
Most Injuries Get Better
One of the most reassuring things I tell patients is this:
The human body is remarkably good at healing.
If you weren't involved in a high-speed car accident, didn't fall off a roof, don't have signs of a serious medical condition, and didn't suffer a catastrophic injury...
...there's a good chance your body is already doing what it was designed to do.
Most muscle strains, ligament sprains, tendon irritations, and episodes of back or neck pain improve substantially over the course of several weeks to a few months.
That doesn't mean they don't hurt.
It doesn't mean rehabilitation isn't valuable.
It simply means that time is often part of the treatment.
Unfortunately, we sometimes act as if every painful shoulder is a torn rotator cuff.
Every sore knee is a meniscus tear.
Every episode of back pain is a herniated disc.
Most of the time, it isn't.
Pain is common.
Catastrophic injury is not.
That's one reason clinicians often recommend conservative treatment first.
Not because they're ignoring the problem.
Because the odds are in your favor.
If your symptoms improve as expected, you've avoided unnecessary imaging, unnecessary expense, and unnecessary worry.
If they don't improve—or if your examination raises concern for something more serious—that's when additional testing becomes much more valuable.
Good medicine isn't about ordering every test as early as possible.
It's about ordering the right test at the right time.
Sometimes the hardest part of recovery isn't convincing the body to heal.
It's having enough confidence to let it.
The Biggest Problem with MRI? There's Usually No "Before" Picture.
Imagine taking a photograph of your car after you notice a dent.
You can clearly see the dent.
What you usually can't tell is when it happened.
Yesterday?
Last year?
Five years ago?
MRI has the same limitation.
For almost every patient, there isn't a scan from before the pain started.
When an MRI shows a disc bulge, meniscus tear, rotator cuff tear, labral tear, or cartilage wear, one of the first questions should be:
"Was this already there?"
Imagine looking at the face of a 60-year-old.
You notice wrinkles.
Nobody asks,
"When did those wrinkles happen?"
We assume they developed gradually over years.
Yet when MRI shows cartilage wear, a degenerative meniscus, or a disc bulge, people often assume it must have happened yesterday because that's when the pain started.
Those are two different questions.
MRI tells us what exists.
It often cannot tell us when it became clinically important.
Without a previous image, we're frequently trying to reconstruct history from a single snapshot.
Most of the time, we honestly don't know.
Research consistently shows that people without pain frequently have these exact findings on MRI (Brinjikji et al., 2015; Guermazi et al., 2012; Teunis et al., 2014).
An MRI captures anatomy at one point in time.
It doesn't tell us whether the finding is new or old.
It doesn't tell us whether it's painful or completely silent.
It doesn't tell us whether it caused today's symptoms or has simply been living there peacefully for years.
This is why clinicians should be cautious about saying,
"We found the problem."
Sometimes we did.
Sometimes we found a problem—but not the problem.
The MRI is a snapshot, not a movie.
Without a previous image, we're often trying to reconstruct the past from a single frame.
Pain Isn't a Picture
One of the biggest mistakes we make in musculoskeletal medicine is assuming anatomy and pain are the same thing.
They're related.
But they aren't identical.
MRI shows anatomy.
Pain is an experience.
Those two things often overlap.
Sometimes they don't.
I've seen patients with massive rotator cuff tears who could still work overhead.
I've seen patients with pristine MRIs who could barely raise their arm.
The question isn't:
"What structure is torn?"
The better question is:
"Why does this person hurt?"
Those aren't always the same question.
The body is more complicated than that.
When the MRI Becomes the Patient
One of the things I dislike most about MRI isn't the technology.
It's what sometimes happens after the report comes back.
Patients stop talking about themselves.
They start talking about their MRI.
"I have a bulging disc."
"I have a torn meniscus."
"I have arthritis."
"My labrum is torn."
Before long, the conversation revolves around damaged structures instead of capable people.
The MRI becomes their identity.
And that's unfortunate, because MRI reports are remarkably good at describing anatomy—but remarkably poor at describing potential.
They don't tell me whether you can walk a mile.
They don't tell me if you can pick up your grandchild.
They don't tell me whether you're getting stronger every week.
They don't tell me whether you're back to gardening, golfing, lifting weights, or sleeping through the night.
As a physical therapist, those are the things I care about.
I care about what you can do today, what you couldn't do last week, and what you'll be able to do next month.
Function is far more meaningful than a paragraph written by a radiologist.
That's because MRI doesn't treat patients.
Clinicians do.
MRI has images.
We have people.
MRI finds anatomy.
We restore function.
Never confuse the two.
My job isn't to treat MRI reports.
My job is to help people move better, hurt less, and regain confidence.
Clinical Reasoning Still Matters
A skilled clinician doesn't ask:
"Can I order an MRI?"
They ask:
"Will this MRI change what I do?"
If the answer is no, immediate imaging may add cost, anxiety, and confusing information without changing treatment.
If the answer is yes—because surgery is being considered, a serious diagnosis is suspected, symptoms are progressing, or red flags are present—MRI becomes incredibly valuable.
That's exactly what it was designed for.
A tool.
Not a reflex.
When MRI Is Absolutely the Right Choice
None of this means MRI is overrated.
Far from it.
MRI is often essential when clinicians suspect:
Major ligament or tendon rupture
Occult fracture
Infection
Tumor
Cauda equina syndrome
Spinal cord compression
Significant neurological deficits
Persistent symptoms despite appropriate conservative care
Situations where surgery is being considered
In these cases, MRI can completely change the treatment plan.
The goal isn't to avoid MRI.
The goal is to order it for the right patient at the right time for the right reason.
The Physical Exam Isn't Dead
Somewhere along the way, we started acting as though the MRI was the diagnosis.
It isn't.
An MRI is an incredibly sophisticated camera.
It shows anatomy.
It doesn't measure pain.
It doesn't tell you why something hurts.
It doesn't reveal movement quality.
It doesn't measure confidence.
It doesn't tell you what you're capable of.
And it certainly doesn't replace listening to a patient.
The best clinicians don't ignore MRI findings.
They simply refuse to let the MRI become louder than the patient.
Clinical Reality
MRI has revolutionized musculoskeletal medicine.
It has saved lives.
It has transformed surgery.
It has changed the way we diagnose disease.
None of that is in question.
But somewhere between radiology suites and Monday Night Football, we started believing something that was never true:
That every painful body part needs an MRI.
It doesn't.
Most musculoskeletal injuries improve.
Many MRI findings were already there before the pain began.
And almost every MRI tells us less about a person's future than we'd like to believe.
MRI is one of the greatest inventions in modern medicine.
But medicine isn't about producing better pictures.
It's about producing better people.
Better movement.
Better function.
Better confidence.
Better lives.
If an MRI helps us get there, that's wonderful.
If it doesn't...
Maybe we should spend a little less time staring at the picture...
...and a little more time looking at the person standing in front of us.
-the Pissed-Off PT- share, suggestions, comments-
References
American College of Radiology. (2021). ACR Appropriateness Criteria®: Low Back Pain.
Roger Chou, Roger A. Deyo, et al. (2009). Imaging Strategies for Low-Back Pain: Systematic Review and Meta-analysis.The Lancet, 373(9662), 463–472.
Amir Qaseem, Timothy J. Wilt, Robert M. McLean, & Mary Ann Forciea. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline.Annals of Internal Medicine, 166(7), 514–530.
Waleed Brinjikji, Patrick H. Luetmer, et al. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.American Journal of Neuroradiology, 36(4), 811–816.
Ali Guermazi, et al. (2012). Prevalence of Abnormalities in Knees Detected by MRI in Adults Without Knee Pain.New England Journal of Medicine, 367, 1817–1825.
T. Teunis, B. Lubberts, B. T. Reilly, & David Ring. (2014). A Systematic Review and Pooled Analysis of the Prevalence of Rotator Cuff Disease With Increasing Age.Journal of Shoulder and Elbow Surgery, 23(12), 1913–1921.
Richard A. Deyo & James N. Weinstein. (2001). Low Back Pain.New England Journal of Medicine, 344(5), 363–370.
John N. Jarvik, et al. (2015). Association of Early Imaging for Back Pain With Clinical Outcomes in Older Adults.JAMA.