Your MRI Isn't the Whole Story: What Elite Climbers' Shoulders Teach Us
You just got your MRI report back.
You scroll through it and the words jump off the page: labral tear. Tendinosis. Cartilage damage. Bursitis.
Suddenly your shoulder feels a lot more fragile than it did five minutes ago.
Here’s what we want you to know: those words describe a picture, not a prognosis.
And one of our favorite studies proves it, using some of the strongest, highest-performing shoulders out there: elite rock climbers.
The Study: 50 Elite Climbers, Zero Shoulder Pain
In 2022, Cooper and colleagues published a study in the Orthopaedic Journal of Sports Medicine that asked a simple question:
What do the shoulders of high-level climbers actually look like on MRI, when nothing hurts?
Here’s how they did it:
50 elite climbers, ages 20 to 60
None had shoulder pain
Both shoulders were examined by orthopaedic sports medicine surgeons
Both shoulders got a high-resolution (3-Tesla) MRI
Two board-certified radiologists read the scans blinded, so they didn’t know anything about the climber attached to each shoulder
These are people hanging off fingertip edges, throwing dynamic moves, and loading their shoulders in extreme positions week after week. Functionally? Their shoulders are thriving.
What the MRIs Showed
If you handed these reports to someone without context, they’d assume these climbers were hurting. Here’s what showed up in shoulders with no pain:
80% had pathology inside the shoulder joint
80% had rotator cuff tendinosis
79% had subacromial bursitis
73% had biceps tendonitis
69% had labral changes, and 56% had a discrete labral tear
57% had cartilage changes on the ball of the shoulder (humeral head)
Read that again: more than half of these pain-free, high-performing athletes had a labral tear on MRI.
Significant on paper. Not significant to the person.
The Twist: The “Torn” Shoulders Moved Better
This part really got our attention.
When the researchers compared climbers with labral tears to climbers without them, the climbers with tears actually had more overhead range of motion, both when they lifted their arm themselves and when it was moved for them.
Not less. More.
That doesn’t mean a labral tear makes your shoulder better. What it suggests is that many of these findings are adaptations to the demands of the sport, the way a shoulder remodels after years of reaching, hanging, and pulling.
And it’s not a one-off. A 2021 study of climbers who had been climbing at a high level for 30 years found they had far more labrum, biceps tendon, and cartilage changes on MRI than non-climbers of the same age. Their shoulder function scores? Better than the non-climbers.
It’s Not Just Climbers
We see the same pattern across overhead athletes:
In elite swimmers, 39 of 40 shoulders had abnormal MRI findings, and the findings looked similar whether the shoulder hurt or not.
In a group of elite overhead athletes, 40% of dominant shoulders showed rotator cuff tears on MRI.
That last study answers the question you’re probably asking right now: “Sure, but won’t those findings catch up with them eventually?”
The researchers checked back 5 years later. None of the athletes had developed shoulder symptoms or needed any treatment. Their conclusion: MRI findings alone shouldn’t be the reason for surgery in this group.
It’s Not Just Shoulders
Zoom out, and the same story shows up all over the body.
Low back: A review of 33 studies covering more than 3,000 people without back pain found disc degeneration on imaging in 37% of 20-year-olds, climbing to 96% of 80-year-olds. The authors’ take: many of these changes are likely part of normal aging, not a source of pain.
Knees: When researchers scanned both knees of 115 adults with no knee pain or injury, 97% of knees showed at least one abnormality on MRI. Some even had meniscal tear types that had never been reported in pain-free knees before.
Hips: A review of pain-free hips found labral injury on MRI in about 68% of hips. In pain-free athletes specifically, another review estimated labral tears in roughly half of them.
And just like the overhead athletes, follow-up tells a similar story. In one group of hockey players with labral tears on their hip MRIs, 10 of 13 were still symptom-free two years later, and the three who did report symptoms hadn’t missed games or needed treatment.
Different joints. Different people. Same lesson.
So What Does This Mean for Your Body?
Imaging is a useful tool. But it’s a snapshot of structure, not a measure of how your body works.
Structure does not equal symptoms.
If you have pain and an MRI full of findings, a few things are worth keeping in mind:
Your findings may have been there long before your pain started. Many of them are common in people with no pain at all.
Pain is influenced by more than tissue. Load, sleep, stress, training changes, and how much capacity your tissues have all play a role.
A finding on paper isn’t automatically a reason for surgery. The question that matters is how you move, how strong you are, and what your body can tolerate.
Your body adapts. The same tissues that show “wear” on a scan can get stronger and more resilient with the right loading.
That’s not to say imaging never matters. Sometimes a finding is the reason for your symptoms, and some injuries do need a surgeon. That’s exactly why the scan has to be matched to you: your history, your exam, and how you move.
Our Approach at Burlington PT
We never treat an MRI report. We treat people.
When you come in with a shoulder that’s bothering you, we look at the whole picture:
strength testing, including end-range strength
movement assessment
what your sport or daily life demands of your shoulder
your imaging, in context
From there, we build a progressive plan to raise your shoulder’s capacity, delivered within 48 hours of your first visit, plus the hands-on work you can’t do on your own.
The Goal Isn’t a “Clean” MRI
The goal is a shoulder that’s strong, capable, and ready for whatever you love to do, whether that’s sending your project, swimming laps, or reaching the top shelf without thinking twice.
Got an MRI report that’s making you nervous?
You’re not alone, and it may be a lot less scary than it sounds. If you want to talk it through, snag a free 30min discovery call. We’re happy to chat and see if we’re a good fit for you.
- The BPT Team
References
Cooper et al. (2022). Shoulder pathology on magnetic resonance imaging in asymptomatic elite-level rock climbers. Orthopaedic Journal of Sports Medicine.
Impact of 30 years’ high-level rock climbing on the shoulder: an MRI study of 31 climbers. Journal of Shoulder and Elbow Surgery, 2021;30(9):2022–2031.
Celliers, Gebremariam & Joubert. Clinically relevant MRI findings in elite swimmers’ shoulders. South African Journal of Radiology.
Connor et al. (2003). Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes. American Journal of Sports Medicine, 31(5):724.
Brinjikji et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4):811–816.
Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. PubMed Central.
Frank et al. (2015). Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy.
Heerey et al. (2019). What is the prevalence of hip intra-articular pathologies and osteoarthritis in active athletes with hip and groin pain compared with those without? Sports Medicine.
More evidence indicates imaging findings do not correlate with hip symptoms (hockey player 2-year follow-up). Lower Extremity Review.