Medical advances are accelerating at an incredible pace. Surgical techniques keep improving, and innovations like stem cells, organ transplants and smart pacemakers are remarkable. But when it comes to musculoskeletal conditions, pain involving muscles, joints, tendons and ligaments, our growing arsenal of high-tech solutions may be doing more harm than good. In our pursuit of answers, we're increasingly medicalizing normal human experiences.
When more care isn't better care
Outdated models of care once promoted routine MRI scans for non-specific, uncomplicated low back pain. While guidelines have evolved, imaging is still frequently overused. Similarly, opioids, injections, NSAIDs and other passive treatments are often prescribed on their own in an attempt to "fix" pain.
Orthopedic surgery has also become a frontline intervention for many conditions, despite strong evidence that surgical outcomes often offer no meaningful advantage over sham surgery for pain or function in non-traumatic cases. That includes procedures such as:
- Non-traumatic meniscus repairs
- Arthroscopic debridement for knee osteoarthritis
- Type II SLAP repairs
- Long head of biceps tenodesis
- Acromioplasty for subacromial impingement
The issue isn't that these interventions never help; it's that they're frequently prioritized before more effective, lower-risk options are explored.
Abnormal is normal
Asymmetries and muscular imbalances are common, and normal. Postures that deviate from a so-called "neutral" position haven't been shown to reliably correlate with pain. Being told that subtle deviations from ideal alignment are causing your symptoms is a classic example of medicalizing normality.
Hot take: with very few exceptions, poor posture is not why you're hurting. More often, pain stems from infrequent quality movement and being under-prepared for activity, not structural flaws.
Imaging findings are not the same as pain
Advanced imaging has reinforced the belief that pain must be explained by visible abnormalities. In reality, many findings on MRI, CT, X-ray and ultrasound reflect normal age-related changes, not injury. Research shows that in pain-free adults over 30, imaging commonly reveals disc degeneration, labral tears, rotator cuff tears, bone spurs, joint inflammation and bone marrow edema.
Even in young athletes without back pain, imaging studies have found disc degeneration, herniation and endplate changes with no direct relationship to symptoms. In a large analysis of more than 41,000 patients referred for spinal imaging, only 2–5% needed immediate or urgent intervention. Imaging for non-emergent pain is often unnecessary and may actually increase fear, distress and overtreatment. (See should you get imaging for back pain?)
Why this matters
We're too quick to assume that small deviations from "ideal" structure are the source of pain, and then try to surgically correct them, even though pain-free people often show the same "abnormalities" on imaging. This flawed reasoning helps explain why many orthopedic surgeries can't guarantee pain relief or full restoration of function.
Where do we go from here?
We need to challenge the belief that more healthcare automatically means better outcomes. For many musculoskeletal conditions, the priority should be education and expectation-setting, lifestyle and activity changes, and active rehabilitation. Pain is complex; not every cause can be seen on imaging or fixed with a procedure, and failing to "fix" an abnormality doesn't mean more damage is happening. (For more, see why oversimplifying health topics leads to misunderstanding.)
How to reduce the harm of too much medicine
Adapted from recommendations published in JOSPT:
| What patients can do | What clinicians can do |
|---|---|
| Ask about all management options, including benefits, risks and timelines | Clearly explain all reasonable options and expected outcomes |
| Ask what you can do to manage your condition | Avoid fear-based language and outdated explanations |
| Ask whether "wait and watch" is appropriate | Understand the natural course of conditions |
| Share your experiences to help improve care | Use imaging judiciously, explain age-related norms and align treatment with patient goals and values |
Want a clear, active plan for your pain without unnecessary scans or procedures? Our physical therapists focus on education, movement and long-term function.
book a sessionthe takeaway
The push to "find and fix" pain often leads to overdiagnosis and overtreatment. Many imaging findings are normal age-related changes, and some common surgeries perform no better than sham. High-value care focuses on education, movement and long-term function.
Frequently asked questions
What does "medicalization of normal" mean?
Treating normal human experiences, like common aches, asymmetries or age-related changes on a scan, as problems that need medical fixes such as imaging, procedures or surgery.
Is bad posture causing my pain?
With very few exceptions, probably not. Postural deviations haven't been shown to reliably correlate with pain; more often, pain comes from infrequent quality movement and being under-prepared for activity.
Do abnormal MRI findings mean I'm injured?
Not necessarily. In pain-free adults over 30, imaging commonly shows disc degeneration, labral tears, rotator cuff tears and bone spurs that reflect normal aging rather than injury.
What questions should I ask my provider?
Ask about all your options with their benefits, risks and timelines, what you can do yourself to manage the condition, and whether "wait and watch" is appropriate.
