When Should Chiropractors Take X-Rays?

by Dr. Nathan Hinkeldey on August 10, 2012


Chiropractor X-Rays

It would seem that many chiropractic patients have become quite accustomed to having an x-ray taken during an initial evaluation. We get calls everyday from people asking, “Do I really need another x-ray?” They explain that they’ve had x-rays taken many times before for the same problem and don’t want to pay for another.

Of course, the other side of that coin is that x-rays have become so commonplace that some patients may feel a chiropractor is cutting corners if he doesn’t insist on taking x-rays!

So the question is: Do you really need a new x-ray upon your first visit to a new chiropractor?

The answer is: Not necessarily.

There are many factors that any doctor must weigh when determining whether an x-ray is appropriate. We’ll take a look at just a few of the key considerations in this post.

Working From The Outside In

Before the need for an x-ray can be established, a medical history and a thorough examination are required. You shouldn’t walk into an office and be escorted directly to the radiology room for an x-ray or lay down and get adjusted without first detailing your personal medical history, the current source and cause of your pain, and then undergoing a physical, orthopedic, neurological, and functional exam.

Pain is Not Enough

Many patients report being told that because they have pain, an x-ray is warranted. While pain is one of the criteria that can constitute the need for an x-ray, it is not, in and of itself, enough. An x-ray should only be taken if your history leads the physician to believe that you may have serious spinal pathology, or if the patient has already undergone 4-6 weeks of conservative care without satisfactory improvement.

Can Taking an X-ray Be Detrimental to the Patient?

Do not panic: One x-ray is not likely to do any harm. However, there are strict guidelines that need to be followed anytime an x-ray is ordered, and that is especially true for children.

Children are still growing, which means that their cells are replicating at higher rates than adults. An x-ray is a form radiation; therefore, increased and frequent exposure does have the potential to result in cell mutations. Of course, this would require much greater dosages than just a single x-ray, but it does mean that doctors should strive to avoid any unnecessary exposure for their young patients.

A Little Knowledge Can Be A Dangerous Thing

Another way that x-rays can be detrimental has to do with how they are used rather than any exposure to radiation. Many physicians like to sit down and show each patient their study, including the x-ray images. And while this seems like a commendable thing for a physician to do, there are studies indicate that showing a patient their x-rays can decrease their rate of progress (1).

Some physicians will take this one step further. They will show a patient all of the areas of degeneration and tell them that the degeneration is causing the pain. However, leading studies refute this idea and show that mild to moderate degeneration does not cause pain (2,3,4). Even though this information has been available for some time, many physicians continue to blame low back pain on degeneration when the fact is that there are many people out there with no back pain that have degeneration. In addition, as you age, you are more likely to have degeneration; therefore, the majority of the time, the x-ray ends up illustrating what was already known and does not change the treatment.

X-Rays Have Their Place

Don’t misunderstand: X-rays are an important diagnostic tool that can provide needed information to doctors and chiropractors. However, over-utilization can have the negative side-effects of needlessly increasing patient cost, exposing patients to radiation unnecessarily, and artificially hindering a speedy recovery. Therefore, prior to obtaining an x-ray, patients should expect to undergo a proper evaluation, including thorough history, physical, orthopedic, neurological, and functional examination. Then, and only then, the physician will then have the necessary information to determine the likelihood that you have serious spinal pathology or pain of musculoskeletal origin. According the most recent ACOEM guidelines, it is appropriate to begin a course of conservative care without taking x-rays if red flags are not present and serious spinal pathology is not suspected. If you have questions about what a thorough evaluation is please don’t hesitate to contact Team Chiropractic and Rehabilitation, your Johnston Chiropractic office.



1.)    Gilbert FJ, Grant AM, Gillan MGC, et al. Does early imaging influence management and improve outcome in patients with low back pain? A pragmatic randomized controlled trial. Health Technology Assessment 2004; 8:1-131.

2.)    Peterson CK, Bolton JE, Wood AR. A cross-sectional study correlating lumbar spine degeneration with disability and pain. Spine 2000, 25(2):218-223.

3.)    Van Tulder MW, Assendelft WJ, Koes BW, Bouter LM. Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine 1997, 22(4):427-434

4.)    Witt I, Vestergaard A, Rosenklint A. A comparative analysis of x-ray findings of the lumbar spine in patients with and without lumbar pain. Spine 1984, 9(3):298-300


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