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Current magnetic resonance imaging (MRI) reports typically emphasize disc degeneration, an age-related and often asymptomatic finding, while overlooking more clinically relevant factors like the state of the muscle. Fat infiltration and muscle wasting seen on MRI scans are common in LBP patients and are potentially reversible with targeted exercise rehabilitation. In a recent case, MRI revealed significant fat infiltration and muscle atrophy, yet the report focused solely on disc changes, missing the elephant in the room: the correctable muscular dysfunction. Since exercise is the cornerstone of LBP management, ignoring modifiable muscle health while highlighting irreversible and non-pathological age-related changes limits targeted treatment guidance. Routine reporting of muscle condition could lead to more precise rehabilitation and improved patient outcomes.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf1120","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T12:51:38Z","timestamp":1767185498000},"source":"Crossref","is-referenced-by-count":0,"title":["MRI scans of the lumbar spine in lower back pain\u2014why are we missing the elephant in the room?"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6131-0398","authenticated-orcid":false,"given":"Mansha","family":"Bhiryani","sequence":"first","affiliation":[{"name":"Countess of Chester Hospital NHS Foundation Trust , Countess of Chester Health Park Liverpool Rd, Chester CH2 1UL ,","place":["United 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