For many years, as an acupuncturist, a large part of my clinical work involved treating neck pain, back pain, shoulder pain, knee pain, etc. These were some of the most common reasons people walked into the clinic.

Often, they had already tried many other approaches. Pain medications. Chiropractic care. Physical therapy. Sometimes even surgery. Some arrived with thick folders of imaging reports—X-rays and MRIs describing bulging discs, degeneration, arthritis, or herniations.

And yet, they were still in pain.

What Helped–At Least at First

Acupuncture has a strong calming effect on the nervous system. It helps move people out of a constant state of tension and vigilance–what we call fight or flight mode—and into a more relaxed state, called rest and digest mode.

I saw time and time again, simply helping a patient relax using acupuncture (and a calm, confident voice) led to a noticeable reduction in pain.

In other cases, releasing very tight muscles with needles (sometimes called “dry needling”) near the site of pain helped. Sometimes the relief lasted a few days. Often, it lasted much longer.

At first, this all seemed straightforward, like from a textbook. Tight muscles hurt. Relax them, and pain improves.

But over time, I started noticing patterns that didn’t quite fit that simple explanation.

When the Pattern Didn’t Make Sense

Some patients would return weeks or months later—not with the same pain, but with pain in a different part of the body.

A person treated for low back pain would come back with neck pain. Someone whose shoulder pain resolved would later complain of hip pain. Occasionally, the pain would disappear altogether—only to be replaced by digestive symptoms.

Like any good clinical, I began asking questions.

If pain were purely the result of a damaged structure, why would it move around? Why would it change form? Why would it sometimes disappear completely—without any structural change?

I also noticed something else that was hard to ignore.

Patients who finally started sleeping well, or who went on vacation, often reported that their symptoms improved dramatically, or vanished entirely.

Then they returned to their normal routines–and the pain came back. Not because they re-injured themselves, but because the stress returned.

At that point, it became clear that what we were taught, that pain is mainly a local, mechanical problem, didn’t fully explain what I was seeing in real people.

Enter the X-Ray

This clinical experience changed the way I thought about imaging.

A patient with back pain gets an X-ray or MRI. The report comes back with phrases like bulging disc, degeneration, or herniation. The conclusion seems to be obvious—these are the causes of the pain.

But here’s the part that often isn’t explained. There are many people walking around with the same findings—or worse—who have no pain at all.

What Imaging Really Shows

Over the past few decades, researchers have taken MRIs of people with no back pain whatsoever. What they found was striking.

By their 30s, over half of people show disc degeneration. By middle age, disc bulges are more common than not. Even disc herniations are found in roughly one-third of young adults with no symptoms.

As people age, these findings become nearly universal.

In other words, many of the abnormalities seen on imaging are normal changes associated with aging, much like wrinkles or gray hair. They describe what a body has lived through–not necessarily what is causing pain.

When Labels Create Fear

Words matter. Being told that your spine is “degenerating” or “damaged” can make movement feel dangerous. People become guarded. Muscles tense. The body stays on high alert. Pain can increase—not because something is being injured, but because the body believes it needs protection.

This helps explain a reality many clinicians quietly observe. Imaging findings are poor predictors of who will hurt, how much, or for how long.

It goes without say, this applies not only to back pain but to most chronic pain. Certainly the kind of chronic pain I saw in my clinic as an acupuncturist.

Finding an Explanation That Fit

Trying to make sense of these patterns eventually led me to the work of Dr. John Sarno, including his book Healing Back Pain.

What struck me was how closely his observations matched what I had already seen in practice.

He described patients whose pain was very real, but not caused by structural damage. Once they truly understood this, their bodies relaxed, and the pain often resolved, sometimes permanently.

This helped explain why relaxation helped so many of my patients. Why pain could move around the body. And why imaging findings so often failed to explain symptoms.

A More Helpful Way to Think About X-Rays and Other Imaging

X-rays and MRIs are valuable tools. They are excellent for ruling out serious problems like fractures, infections, or tumors.

But when it comes to chronic pain, they often tell an incomplete story.

They show anatomy, but don’t necessarily give us a meaningful diagnosis.

When serious conditions have been ruled out, focusing too much on imaging can actually keep people stuck by reinforcing fear.

The Takeaway

So, with this new paradigm, I was able to educate patients and treat them in a new way.

For chronic pain patients, I began to teach them their backs, necks, and knees are just not as fragile as they believed. That most “abnormalities” are simply signs of having lived in a human body for a few decades. With some courage, most were able to get back to normal function.

If you’ve been told you have a “bad back,” it’s worth knowing this:
Many people with the same imaging findings live full, active, pain-free lives.

Sometimes, healing begins not with another test, but with understanding how resilient the body truly is and how stress affects the body and how to deal with it.

Resources for Learning More

For readers who want to explore these ideas more deeply, here are a few trustworthy, practical resources that many people have found helpful:

• Dr. John Sarno
  Healing Back Pain
  A clear, accessible introduction to understanding chronic pain that is not driven by structural damage. Sarno’s work has helped millions rethink pain and recovery.
• Alan Gordon
  The Way Out
  A modern, compassionate guide to working with chronic pain and fear. Especially helpful for people who want practical tools, not just theory.
• Dr. Howard Schubiner
  Unlearn Your Pain (online course on Coursera)
  A structured, research-based program taught by a practicing physician, designed to help people understand and work through chronic pain patterns step by step.

None of these resources deny the reality of pain or the importance of medical care. Instead, they help explain why pain can persist even when imaging looks alarming, and how understanding the body more accurately can be a powerful part of healing.