Your Knee MRI Shows Damage. Does That Explain Your Pain? — Muscle IQ in Orem

You finally got the scan. The report lists a meniscus tear, worn cartilage, maybe a bone bruise, and it sounds like an answer. For many people in Orem and across Utah County, that report becomes the whole story of their knee, and the next step feels decided.

But a picture of the inside of your knee and the reason your knee hurts are not always the same thing. Here is why that matters if you are weighing your next step.

What researchers found in knees that did not hurt

In a 2020 study published in Skeletal Radiology, researchers took high-resolution MRI scans of both knees in 115 adults who reported essentially no knee problems on a standard knee questionnaire. That made 230 pain-free knees.

Nearly all of them showed something. About 97 percent had at least one structural abnormality. Roughly 30 percent had a meniscal tear (a tear in the knee's cushioning cartilage), more than 60 percent had cartilage changes, and about half had bone marrow edema (fluid signal inside the bone, sometimes called a bone bruise). Findings were more common with age, but even in adults under 40, about 40 percent of knees showed moderate-to-severe cartilage changes. The group was mostly sedentary adults with a median age of 44.

This was one group of adults scanned once, so it cannot tell you what is happening in your knee. What the authors concluded is worth reading closely, though: a scan should not stand alone, and diagnosis should rest primarily on your history and a hands-on exam.

So why does the knee hurt?

Injured tissue can absolutely be part of it. When tissue around a joint is irritated, it can thicken and stiffen, and the nerve endings inside it become more sensitive. That is a real source of pain, and it deserves treatment.

Here is the piece a scan cannot show. Pain does not only sit in the tissue. It can turn down what we call the muscle tone dial: how strongly your nervous system tells a muscle to fire. When the muscles around your knee go offline, they protect the joint less, neighboring muscles overwork, and more strain lands on the tissues that were already irritated. Weak muscles do not protect tissue. Strong muscles do.

Pain can cause muscle weakness, and muscle weakness can cause pain. Two people can have the same picture on an MRI and very different muscle function, which may be part of why one has pain and the other does not.

What we look at that a scan cannot show

An MRI shows what your knee looks like. A hands-on strength evaluation shows how well your muscles are working, and that is where a physical therapist looks.

At Muscle IQ in Orem, a visit starts with a long, hands-on evaluation that includes strength testing, because we want to know which muscles are working at full strength and which are being held back. We then treat, and test again. If a muscle tests stronger after treatment, that tells us we are on the right track. You can read more about how we approach knee pain at Muscle IQ and about muscle inhibition, the idea that a muscle can be switched down even when nothing is wrong with the muscle itself.

Imaging still has a role. Physical therapists in Utah can order MRI and X-ray, and Muscle IQ does so when the result is likely to change the plan. You can see which regions are covered on our MRI and X-ray page. The point is that the scan is one piece of the picture, not the verdict.

What this does not mean

A tear on your MRI is not imaginary, and this is not a reason to ignore your scan or your physician's advice. Decisions about surgery belong to you and your surgeon, and this post is not medical advice for your knee. A knee that locks, gives way, swells quickly after an injury, or has hurt since a significant fall should be looked at promptly, and your surgeon and your therapist can work together on it.

What it does mean is that a structural finding alone does not tell you whether surgery is your only path. A finding like "torn" or "bone on bone" describes structure. It does not tell you how well the muscles around the knee are working, and that is worth testing too.

Back to the stairs, the trail, and the court

The goal is not a better-looking scan. It is getting you back to walking the Provo River Trail, climbing stairs without bracing, and playing the sports you love. Finding which muscles are being held back is where care at Muscle IQ begins, and improving muscle function may help you move with less pain.

If you have a knee MRI in hand, bring the report to your first visit.

Take control of your health today by calling Muscle IQ at (801) 310-0851 to schedule your first appointment.

Learn more at MuscleIQ.com.