Do You Need X-Rays Before Chiropractic Care? Why We Take a Selective Approach
At Sikorsky Chiropractic, we believe diagnostic testing should have a purpose. X-rays can provide valuable information about the spine, but that does not mean every patient needs an X-ray before beginning chiropractic care.
Current research and clinical guidelines support a more selective approach to spinal imaging. Instead of routinely taking X-rays on every patient, the decision should be based on your health history, symptoms, examination findings, and whether the results are likely to affect your treatment plan.
Why Aren’t X-Rays Necessary for Everyone?
For many patients with uncomplicated low back pain, routine X-rays have not been shown to improve treatment outcomes.
If you are wondering about the necessity of chiropractic X-rays in Elgin IL, it’s important to consult with your chiropractor to determine if they are appropriate for your situation. Understanding the role of chiropractic X-rays in Elgin IL can help you make informed decisions about your care.
Organizations including the American College of Radiology and American Chiropractic Association recommend against routine imaging for many patients with acute low back pain when there are no warning signs or other clinical reasons for imaging.
This does not mean X-rays are unnecessary. It means they should be used when the information they provide can help with diagnosis, safety, or treatment decisions.
What Can Show Up on an X-Ray?
Understanding Chiropractic X-Rays in Elgin IL
One reason X-rays need to be interpreted carefully is that they frequently show changes that may not be responsible for a patient’s pain.
Common findings can include:
- Arthritis and degenerative changes
- Bone spurs
- Changes in disc height
- Spondylosis
- Postural or structural variations
Many of these findings become more common as we age and can also be present in people who have little or no pain.
Seeing “degeneration” or “arthritis” on an X-ray does not automatically tell us why someone hurts or how much pain they should be experiencing. Imaging findings need to be considered along with the patient’s symptoms and examination.
When Are X-Rays Appropriate?
There are situations where imaging can be very important.
A chiropractor may recommend X-rays or other imaging when the patient’s history or examination raises concern about:
- Significant trauma or a possible fracture
- Progressive neurological symptoms
- Infection
- Cancer or other serious underlying disease
- Significant structural abnormalities
- Certain inflammatory conditions
- Osteoporosis or increased fracture risk
- Symptoms or examination findings that require further investigation
Imaging may also be considered when the results could meaningfully change how a patient is treated or whether referral to another healthcare provider is necessary.
Depending on the suspected condition, an X-ray may not always be the best test. In some situations, MRI, CT, or another diagnostic study may provide more useful information.
Why Avoid Unnecessary X-Rays?
Modern diagnostic X-rays generally involve relatively low levels of radiation, but medical radiation exposure should still be kept as low as reasonably achievable.
This is commonly known as the ALARA principle: As Low As Reasonably Achievable.
If an X-ray is clinically necessary, its benefits can outweigh the radiation exposure. If the image is unlikely to provide useful information or change treatment, exposing a patient to radiation may not provide additional value.
There is also another consideration: overdiagnosis.
An X-ray may reveal age-related or incidental findings that sound concerning but have little relationship to the patient’s symptoms. When these findings are not properly explained, they can create unnecessary worry and make someone believe their spine is more damaged or fragile than it actually is.
Should X-Rays Be Used to Track Chiropractic Progress?
For most patients with low back pain, routinely repeating X-rays simply to monitor treatment progress is not supported by current evidence.
Changes in pain, mobility, strength, function, activity level, and the physical examination generally provide more meaningful information about how a patient is responding to care.
Repeat imaging can still be appropriate when there is a significant clinical reason, such as worsening symptoms, a change in diagnosis, new trauma, or concern about another condition.
Our Approach at Sikorsky Chiropractic
At Sikorsky Chiropractic, we do not believe in taking an X-ray simply because someone walked through the door.
We start by listening to the patient, reviewing their health history, and performing an appropriate examination. From there, we determine whether imaging is necessary and whether the results are likely to provide useful information.
Sometimes an X-ray is an important part of that process. Other times, the history and examination give us the information we need to move forward without unnecessary imaging.
Our goal is simple: use the right test for the right patient at the right time.
If you are experiencing back pain, neck pain, or another musculoskeletal problem and are wondering whether you need X-rays, contact Sikorsky Chiropractic in Elgin, Illinois. We can evaluate your condition and determine whether imaging should be part of your care.
Frequently Asked Questions
Do I need an X-ray before my first chiropractic adjustment?
Not necessarily. Whether imaging is appropriate depends on your symptoms, health history, examination findings, age, previous injuries, and other individual factors.
Can a chiropractor order X-rays?
Yes. Chiropractors can use diagnostic imaging as part of evaluating patients when clinically appropriate.
Does arthritis on an X-ray mean it is causing my pain?
Not always. Degenerative changes become increasingly common with age and do not necessarily correlate with the location or severity of a person’s symptoms. Imaging should be interpreted alongside your history and physical examination.
Are chiropractic X-rays safe?
Diagnostic X-rays use ionizing radiation. Although the amount used in modern radiography is generally relatively low, unnecessary exposure should still be avoided. Imaging should be ordered when the expected clinical benefit justifies it.
Why would my chiropractor recommend an MRI instead of an X-ray?
X-rays are particularly useful for evaluating bones and certain structural changes. MRI provides much more information about soft tissues, including discs, nerves, the spinal cord, and other structures. The appropriate test depends on what your doctor is investigating.
References
- Hutchins TA, Peckham M, Shah LM, et al. ACR Appropriateness Criteria® Low Back Pain: 2021 Update. Journal of the American College of Radiology. 2021;18(11 Suppl):S361-S379.
- American College of Radiology. ACR Appropriateness Criteria®: Low Back Pain. Revised 2021.
- Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropractic & Manual Therapies. 2018;26:48.
- Corso M, Cancelliere C, Mior S, Kumar V, Smith A, Côté P. The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature. Chiropractic & Manual Therapies. 2020;28:33.
- Readford TR, Hayes M, Reed WM. Factors affecting chiropractor requests for full-length spinal radiography: a scoping review. Journal of Medical Radiation Sciences. 2022;69(2):236-249.
- Hall AM, Aubrey-Bassler K, Thorne B, Maher CG. Do not routinely offer imaging for uncomplicated low back pain. BMJ. 2021;372:n291.
- Chou R, Qaseem A, Owens DK, Shekelle P. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Annals of Internal Medicine. 2011;154(3):181-189.
- Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain. Annals of Internal Medicine. 2017;166(7):514-530.