Many patients who present to our office for the first time expect that x-rays will be a part of the assessment process. After all, what better way to see what’s really “going on” in there? But more often than not, we find that x-rays aren’t necessary. The truth is that x-rays actually tell us very little about the origin of most people’s back or neck pain. Most people present with mechanical pain. In other words, the parts are ok, they’re just not moving properly. And it’s precisely this movement that cannot be seen on an x-ray. A thorough history, range of motion testing and palpation are more revealing about a patient’s pain than just a static picture of bones. And even if those bones are wearing down, or degenerating, the recommended treatment will usually remain the same. A recent research review published in the Journal of Chiropractic and Manual Therapies confirmed that x-rays aren’t very useful for routine screening. The authors concluded the following:
We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients.
It is important to note, however, that there are situations where x-rays should be taken. These are the “red flags” mentioned above. These include things such as a history of trauma, a lack of responsiveness to conservative management, a history of cancer and/or advanced age. A comprehensive history will reveal if any of these red flags are present.
So while x-rays can be a valuable tool for a chiropractor in some situations, more often than not, the right questions and a thorough examination will be enough to lead to an accurate diagnosis and an appropriate treatment plan.
Corso, M., Cancelliere, C., Mior, S. et al. The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature. Chiropr Man Therap 28, 33 (2020).