The Short Answer
Sometimes imaging is exactly what you need. Sometimes it adds nothing useful and can actually slow down your recovery. The difference depends on your specific situation, not a blanket rule.
At 417 Performance, we order imaging when it will genuinely change your treatment plan. We skip it when the findings won't affect what we do next. This follows the same evidence-based guidelines used by the American College of Physicians, the American Physical Therapy Association, and the American Chiropractic Association.
When Imaging Helps
There are clear situations where getting a scan is the right call:
- After significant trauma. Car accidents, hard falls, awkward landings, or collision injuries where a fracture or structural damage is a real possibility.
- Neurological symptoms that are progressing. Worsening numbness, tingling, or weakness, especially if it's spreading or getting more severe over days or weeks.
- Red flags for serious conditions. Unexplained weight loss combined with pain, fever with joint or spine symptoms, or a history of cancer with new pain all warrant investigation.
- Symptoms that don't respond to quality rehab. If you've put in consistent work for 6 to 12 weeks and you're not improving the way we'd expect, imaging helps us understand why.
- When surgery or injection is being considered. If the next step might be a procedure, we need to see what we're working with.
- Acute loss of function after injury. Sudden inability to raise your arm after a fall, or a knee that locks and won't straighten, may indicate something that benefits from early imaging.
When Imaging Often Doesn't Change Care
For many common conditions, scans show findings that look concerning but don't actually guide treatment:
- Overuse and overload injuries. Tendinopathies, muscle strains, and most non-traumatic pain respond to progressive loading and movement work regardless of what imaging shows.
- Pain tied to movement or strength deficits. If your shoulder hurts when you press overhead but feels fine otherwise, and your movement screen shows obvious restrictions, we already know where to start.
- Gradual onset pain without trauma. The ache that built up over weeks or months is rarely something a scan will solve. These respond to addressing the load, movement, and recovery factors that caused them.
- Early-stage symptoms. Most acute back pain, neck pain, and joint pain improves significantly within the first six weeks. Scanning during this window rarely changes the plan.
The Problem With Over-Imaging
Here's something that surprises most people: MRI findings that sound alarming are incredibly common in people with zero pain.
Research on pain-free adults shows that by age 50, 80% have disc degeneration visible on MRI. Disc bulges show up in 60% of pain-free 50-year-olds. Rotator cuff changes appear in up to 47% of people with no shoulder symptoms. Nearly a third of athletes with healthy, pain-free knees have meniscal findings on imaging.These aren't problems waiting to happen. They're normal age-related changes, like gray hair on the inside.
The issue is that when you see these findings on your scan, it's hard not to worry. Words like "degeneration," "tear," or "herniation" sound serious. But in most cases, these findings were there before your pain started and will be there after your pain resolves. Treating the image instead of treating you can lead to unnecessary procedures, prolonged fear of movement, and slower recovery.
Your pain is real. The picture just doesn't always explain it.
How We Decide
We follow a structured process to determine if imaging makes sense for you:
- Thorough history. How did this start? What makes it better or worse? Any trauma? Any symptoms that suggest something more serious?
- Physical assessment. We test your movement, strength, and specific structures to understand what's contributing to your pain.
- Red flag screening. Every evaluation includes a check for signs that would make imaging necessary right away.
- Response to treatment. For most conditions, we expect meaningful improvement within the first few weeks of targeted care. How you respond tells us a lot.
- Ongoing monitoring. If progress stalls or something changes, we reassess. Imaging becomes more valuable after we've ruled out the common, treatable causes.
This approach means you get imaging when it will actually inform your care, not just because it feels like the next logical step.
How We Handle Imaging
If you need imaging, we have options to get you answers quickly.
We partner with a local imaging center, so we can order X-rays or MRIs directly and get you scheduled without extra steps. If you'd prefer to go through your primary care physician instead, that works too. Some people have an established relationship with their PCP and want to keep everything in one place. Either route gets you where you need to go.
The goal is simple: get the information that helps us help you, as efficiently as possible.
If you already have imaging from a previous visit or another provider, bring it. We'll review it alongside your clinical picture and put those findings in context. A scan result on its own rarely tells the whole story.
Frequently Asked Questions
We can order imaging directly through our partner imaging center. If you'd rather go through your primary care physician, that's completely fine too. Whichever route is easier for you.
Yes. We'll review your images and reports alongside our clinical findings. Sometimes the scan explains a lot. Sometimes the findings are incidental and the real issue is something we can address in the clinic.
For most non-traumatic conditions without red flags, guidelines recommend 6 to 12 weeks of quality conservative care before imaging. If something isn't progressing the way it should, we'll have that conversation with you sooner.
Get the scan. Your physician has information we may not yet have, and imaging they recommend is likely for good reason. Bring the results to your appointment and we'll factor them into your treatment plan.
Absolutely. If at any point we believe a scan would change your care or rule out something serious, we'll let you know directly and help you get it scheduled.
Not Sure What You Need?
We'll assess your situation, screen for anything that needs immediate attention, and give you a clear recommendation on next steps.
