Chiropractic and x-rays, for most of their history, have gone together like peanut butter and jelly or Forrest Gump and Jenny.
Fun fact: Chiropractic and x-rays were “discovered” the same year, 1895.
It makes sense that x-rays would become a much relied on tool within chiropractic. One of the initial theories in chiropractic was that a vertebra in the spine would become misplaced and impinge or pinch a nerve.
Using an x-ray, chiropractors theorized they could identify the “bone out of place” and use an adjustment to put it back in place.
A lot has changed since then.
X-rays have improved, other imaging methods and diagnostic tests have been invented, and the research on how chiropractic works has grown.
For the most part, chiropractors no longer hold to the “bone out of place” model and as we’ve moved away from that theory our reliance on x-rays have decreased as well.
Do you need an x-ray to see a chiropractor?
The short answer is no but hang with me for a minute because there are times when imaging is important. I don’t want you to think you never need an x-ray or other imaging.
The Problem With Imaging
The first problem we have is that imaging methods, like x-ray and MRI, can be remarkably inconsistent. Research has shown that what is shown on imaging doesn’t necessarily correlate with the symptoms a person presents with and is a poor predictor of whether your back pain will get worse (1, 2).
Unnecessary imaging can also lead to unnecessary treatments. For instance, how you are positioned when you have an x-ray taken can make your spine look as though it has a decreased curve in the neck or lower back which some chiropractors will try to correct with multiple visits. These unnecessary treatments aren’t just limited to chiropractors either.
It becomes much more concerning when imaging findings, like herniated discs, lead to surgeries which carry a much greater risk to you, the patient (3). Not only is the cost much more than conservative treatment, but even when a back surgery is “successful”, it can lead to a number of problems in the future such as accelerated degeneration.
Another issue that arises when we get x-rays or MRIs first is that your healthcare provider can get “clinical blinders” when they find something on the imaging. What I mean by “clinical blinders” is they stop looking for the source of the problem because they see something on an x-ray, like arthritis/degeneration or a herniated disc.
Imaging should just be part of a patient’s clinical picture. That means that we have to take into account what a patient tells us about their symptoms, their previous medical history, what we find during our physical examination which should include some sort of orthopedic testing (you’d be amazed how many times I’ve had a patient tell me they saw their primary doctor for some back/neck/shoulder pain and they didn’t touch or move the affected area, but I digress…) and then, if needed, what we find on an x-ray or MRI.
Lastly, we do need to take into account radiation exposure. Although radiology has come a long way since it was invented (the first x-rays took closer to an hour to develop versus milliseconds today), they still expose patients to radiation. The main concern is not so much getting an x-ray from time to time but multiple x-rays over a rather short period of time.
So, our goal as healthcare providers should be to only expose patients to those risks only when the benefits are greater.
When You Should Get An X-Ray
Now that I’ve talked about everything wrong with x-rays, I want to talk about when you need one because there are definite benefits to the right imaging in the right circumstances.
The first case you need an x-ray before treatment is if your symptoms were caused by trauma i.e. you were in a car wreck, got hit by something, fell off a building, so on.
Obviously, we have to be concerned about ruling out fractures and other internal injuries when you’ve been in a trauma so imaging is definitely justified in this circumstance.
Another instance when you may need further imaging is to rule out things that are called “red flags”.
Red flags are conditions that would keep you from receiving care at whatever healthcare office you happen to be in. A potential red flag could be hinted at based on the history of your condition or some findings during your physical exam.
Depending on what we think is going on, you’d be referred for imaging, to another healthcare provider, or even the emergency room. In these situations, it is vital that you follow your healthcare provider’s recommendations because this could be a potentially serious situation.
The last situation imaging is usually warranted is if you don’t respond to a trail of conservative care.
If your pain or other symptoms aren’t getting any better then that may be an indication that they are being caused by something else which would require further testing.
X-ray and other types of advanced imaging are absolutely useful tools when used in an appropriate manner.
I will say there are some chiropractic techniques out there that teach chiropractors to adjust based off what they see on an x-ray so they will x-ray every patient that comes in.
If you go to a chiropractor that does one of these techniques and you feel that you are getting good results and are comfortable with that type of treatment, then, by all means, continue to go to them.
Don’t walk into your next appointment and say, “I read a blog post from a chiropractor that says you should stop x-raying me.” If that’s the way they want to practice and you are okay with it then that is your decision to continue care.
Part of practicing evidence-based medicine is taking into account patient preferences.
On the other hand, if you go to a chiropractor for the first time and they x-ray all new patients regardless of their history and you’re not okay with that then find another one. Don’t let them pressure you into something you’re not comfortable with.
Remember, x-rays and other types of imaging are just a part of your overall clinical picture and shouldn’t be solely relied upon to make treatment decisions.
There are plenty of chiropractors out there treating patients and getting great results without using an x-ray on the initial visit.
I hope this post helps you to make a more informed decision the next time you decide to visit a chiropractor. If you liked it, please consider sharing it and head over to our Facebook page and give us a “Like”. It’s a great place to interact with us and get your questions answered.
- Scavone, J. (1981). Use of lumbar spine films. Statistical evaluation at a university teaching hospital. JAMA: The Journal of the American Medical Association, 246(10), pp.1105-1108.
- Borenstein, D., O'Mara, J., Boden, S., Lauerman, W., Jacobson, A., Platenberg, C., Schellinger, D. and Wiesel, S. (2001). The Value of Magnetic Resonance Imaging of the Lumbar Spine to Predict Low-Back Pain in Asymptomatic Subjects. The Journal of Bone and Joint Surgery-American Volume, 83(9), pp.1306-1311.
- Fritz, J., Brennan, G. and Hunter, S. (2015). Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges. Health Services Research, 50(6), pp.1927-1940.