​Not all tissues show up on every scan.
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Muscle, fascia, or other irritable tissues may not show up on your scan, meaning you may experience a lot of pain but have a completely normal scan. Not all parts of your anatomy will show up from every scan's perspective and some tissue changes might only be evident in certain postures.

Age-related changes are normal and may not be related to your pain.

Results such as arthritis, disc bulges, and small tears can be concerning. However, it's helpful to note that people who have no painful symptoms can have similar, if not more, age-related changes and these signs may not be related to your pain at all.

Severe pain may not be related to severe changes on MRI.

Pain is a complex experience, influenced by multiple factors including the sensitivity of the tissues involved, what the brain believes about the pain and what it means, and how long it has been present. MRI is helpful for ruling out severe pathology such as infection, fracture, or malignancy, but it is not always an accurate guide to the source of symptoms. The results of an MRI should always be taken into account as a small part of a bigger clinical picture when guiding treatment.
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Talk to your physiotherapist for advice on any imaging results you have and what they might mean for your treatment and prognosis. None of the information in this article is a replacement for professional medical advice. Always consult a medical professional for advice on your condition.

What is spinal stenosis?
 
The spinal cord, nerves and arteries are housed by the spine, which acts as a hard casing to support and protect these vulnerable structures. The spine has a hollow column that allows the spinal cord to run from the brain to the rest of the body. At each spinal segment, nerves exit the spine and supply the tissues of the body. There is also an intricate network of small veins and arteries that provide blood to the spinal cord and vertebrae, providing them with the nutrients needed to operate.
 
Spinal stenosis is characterized by a narrowing of the spaces that house the spinal cord, nerves and blood supply. A variety of factors can cause spinal stenosis, however overwhelmingly it is caused by degenerative changes to the spine as we age. Many people over the age of 60 will have a degree of spinal stenosis, however not all will have pain. Clinically, spinal stenosis is often used to describe the painful symptoms of this condition rather than just the narrowing itself.

What are the symptoms?

Pain with walking or standing that radiates into the hips, thighs and even as far as the feet is the hallmark of spinal stenosis. Usually, this pain will be reduced with rest and forward movements of the spine. Spinal stenosis is a progressive condition and symptoms will gradually increase over time. The pain is often described as a deep ache and can be associated with fatigue, heaviness, weakness and numbness. It can affect just one leg, but often will be felt in both legs.  There will often be associated back pain, however leg pain is usually the most severe complaint.

How can physiotherapy help?

There are many conditions that need to be excluded before a diagnosis can be made. Your physiotherapist is able to conduct a thorough examination and accurately diagnose this condition. In some cases, imaging may be requested. As mentioned earlier, many people have stenotic spinal changes without symptoms. Surgery to decompress the restricted nerves and stabilize the spine can be used in very severe cases. 

For mild to moderate cases of spinal stenosis, physiotherapy can be extremely beneficial.  Your physiotherapist can help you manage your pain through hands-on techniques and by providing a targeted exercise program based on biomechanical assessment. They are also able to help you to understand and manage your day in a way that helps to reduce flare-ups and maintain muscle strength.

Occasionally surgery is the right choice for you, then your physiotherapist is able to guide you through this treatment pathway, helping you to prepare and recover from surgery to get the best overall outcome possible.