Episode 44: John Gilliam on Abnormal Imaging in Pain-Free Populations & Client Expectations on Outcomes

Episode 44 of the Strength Ratio Podcast features John Gilliam, Doctor of Physical Therapy (DPT) and Certified Strength and Conditioning Specialist (CSCS).

John discusses two primary topics on the show. The first topic involves a literature review of abnormal images on MRI in asymptomatic subjects. Simply speaking, he talks about how someone can get a picture that looks bad, but whose function is great.

One such example is that among pain-free populations in their 30’s, 40’s and 50’s, prevalence rates of disc degeneration are 52%, 68% and 80%, respectively (Brinjikji et al).

Over the past two to three decades, such evidence has abounded for every major joint in the body. These findings have created a more comprehensive and effective approach to pain treatment, known as the biopsychosocial approach. This approach leads into John’s second topic, which explores client expectations in the rehabilitation process.

John uses a method of communication called Motivational Interviewing to educate and to empower clients for improved and realistic expectations surrounding their healing process.

John has provided an extensive bibliography (below), for those who would like to further explore these two topics.


Musculoskeletal imaging findings in asymptomatic people.

Lumbar Spine

  • Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal Of Neuroradiology. 2015;36(4):811-816. doi:10.3174/ajnr.A4173.

  • Boden SD, Davis DO, Dina TS, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects: a prospective investigation. J Bone Joint Surg Am 1990;72:403–08

  • Kalichman L, Kim DH, Li L, et al. Computed tomography-evaluated features of spinal degeneration: prevalence, intercorrelation, and association with self-reported low back pain. Spine J 2010;10: 200 –08

  • Wiesel SW, Tsourmas N, Feffer HL, et al. A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine (Phila Pa 1976) 1984;9:549 –51

Cervical spine

  • Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine. 2015;40(6):392-398. doi:10.1097/BRS.0000000000000775

  • Boden, S. The Journal of bone and joint surgery. American volume Volume: 72 Issue 8 (1990) ISSN: 0021-9355 Online ISSN: 1535-1386


  • Abe I, Harada Y, Oinuma K, et al. Acetabular labrum: abnormal findings at MR imaging in asymptomatic hips. Radiology. 2000;216(2):576-581.

  • Silvis ML, Mosher TJ, Smetana BS, et al. High Prevalence of Pelvic and Hip Magnetic Resonance Imaging Findings in Asymptomatic Collegiate and Professional Hockey Players. American Journal of Sports Medicine. 2011;39(4):715-721.

  • Gallo, R. A., Silvis, M. L., Smetana, B., Stuck, D., Lynch, S. A., Mosher, T. J., & Black, K. P. (2014). Asymptomatic hip/groin pathology identified on magnetic resonance imaging of professional hockey players: Outcomes and playing status at 4 years' follow-up. Arthroscopy - Journal of Arthroscopic and Related Surgery, 30(10), 1222-1228. https://doi.org/10.1016/j.arthro.2014.04.100


  • Keng A, Sayre EC, Guermazi A, et al. Association of body mass index with knee cartilage damage in an asymptomatic population-based study. BMC Musculoskeletal Disorders. 2017;18(1):517. doi:10.1186/s12891-017-1884-7.

  • Guermazi A, Niu J, Hayashi D, Roemer FW, Englund M, Neogi T, et al. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham osteoarthritis study). BMJ. 2012;345:e5339.

  • Brennan SL, Cicuttini FM, Pasco JA, Henry MJ, Wang Y, Kotowicz MA, et al. Does an increase in body mass index over 10 years affect knee structure in a population-based cohort study of adult women? Arthritis Res Ther. 2010;12:R139.

  • Wang Y, Wluka AE, English DR, Teichtahl AJ, Giles GG, O’Sullivan R, et al. Body composition and knee cartilage properties in healthy, community based adults. Ann Rheum Dis. 2007;66:1244–8.

  • Stehling C, Lane NE, Nevitt MC, Lynch J, McCulloch CE, Link TM. Subjects with higher physical activity levels have more severe focal knee lesions diagnosed with 3T MRI: analysis of a non-symptomatic cohort of the osteoarthritis initiative. Osteoarthr Cartil. 2010;18:776–86.

  • Stehling C, Liebl H, Krug R, Lane NE, Nevitt MC, Lynch J, et al. Patellar cartilage: T2 values and morphologic abnormalities at 3.0-T MR imaging in relation to physical activity in asymptomatic subjects from the osteoarthritis initiative 1. Radiology. 2010;254:509–20. Radiological Society of North America, Inc.

  • Laberge MA, Baum T, Virayavanich W, Nardo L, Nevitt MC, Lynch J, et al. Obesity increases the prevalence and severity of focal knee abnormalities diagnosed using 3T MRI in middle-aged subjects–data from the osteoarthritis initiative. Skelet Radiol. 2012;41:633–4.


  • Johansson FR, Skillgate E, Adolfsson A, et al. Asymptomatic Elite Adolescent Tennis Players’ Signs of Tendinosis in Their Dominant Shoulder Compared With Their Nondominant Shoulder. Journal of Athletic Training (Allen Press). 2015;50(12):1299-1305.

  • Lesniak BP, Baraga MG, Jose J, Smith MK, Cunningham S, Kaplan LD. Glenohumeral Findings on Magnetic Resonance Imaging Correlate With Innings Pitched in Asymptomatic Pitchers. American Journal of Sports Medicine. 2013;41(9):2022-2027.

More Limited Review on Expectations for Outcome


  • Bialosky JE, Bishop MD, Cleland JA. Individual Expectation: An Overlooked, but Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain. Physical Therapy. 2010;90(9):1345-1355. doi:10.2522/ptj.20090306

Low back pain

  • Kongsted A, Vach W, Axø M, Bech RN, Hestbaek L. Expectation of recovery from low back pain: a longitudinal cohort study investigating patient characteristics related to expectations and the association between expectations and 3-month outcome. Spine. 2014;39(1):81-90. doi:10.1097/BRS.0000000000000059.

  • Steenstra I, Munhall C, Irvin E, et al. Systematic Review of Prognostic Factors for Return to Work in Workers with Sub Acute and Chronic Low Back Pain. Journal of Occupational Rehabilitation. 2017;27(3):369-381. doi:10.1007/s10926-016-9666-x.

Cervical Spine

  • BISHOP MD, MINTKEN P, BIALIOSKY JE, CLELAND JA. Patient Expectations of Benefit From Interventions for Neck Pain and Resulting Influence on Outcomes. Journal of Orthopaedic & Sports Physical Therapy. 2013;43(7):457-465.


  • Chester R, Jerosch-Herold, Lewis J, Shepstone L. 2018. Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. Br J Sports Med. 2018 Feb;52(4):269-275. doi: 10.1136/bjsports-2016-096084. Epub 2016 Jul 21.