Why We Don’t Take X-rays

hen it comes to low back pain and routine x-rays, less is more.

Treatment plans for lower back pain no longer require routine x-ray imaging. A 2011 meta-analysis of six randomized controlled trials of 1,804 patients with acute or sub-acute lower back pain and signs or symptoms of a specific underlying condition did not find a difference in terms of pain, function, quality of life or overall patient-rated improvement whether routine lumbar imaging was performed.

Most abnormalities noted on x-rays are common in people without low-back pain and are loosely associated with back pain symptoms.

Today’s chiropractic care using the Activator Method® does not require the use of x-rays in order to initiate the process of restoring spinal balance in a patient. Instead, this instrument-based chiropractic technique utilizes specific protocols to detect spinal joint dysfunction, analyze leg length inequality, identify issues with body mechanics, and test neurological reflexes.

Evidence-based recommendations within the field of chiropractic care clearly define* when x-rays are needed for patients with low-back pain:

  • Recent trauma with suspicion of injury

  • Severe or progressive neurological deficit

  • Non responsive to four (4) weeks of conservative treatment

Granted, x-rays will commonly be required as a preliminary study when referral for other studies are needed, such as an MRI or CT.

Even the American College of Physicians (ACP) recently found strong evidence that routine x-rays does not improve clinical outcomes and may expose patients to preventable harm. However, in a recent survey, approximately 40% of internal medicine physicians reported ordering routine x-rays for acute low-back pain.

Adhering to the best current evidence about the use of imaging reduces overuse, most chiropractic patients do not need immediate imaging and will benefit from an initial trial of chiropractic, massage or laser therapy. Key chiropractic management principles to guide imaging decisions include a thorough history and physical examination, as well as effective communication with the patient.

In the unusual event that our doctors determine x-rays are necessary, we have radiology privileges at Mercy Medical Center, and can order any necessary tests.

In the end, at Hartville Health & Wellness Centre we do not take x-rays because we are committed to providing all the care and only the care known to be effective.


*Souza TA, Differential Diagnosis and Management for the Chiropractor: Protocols and Algorithms, 4th Ed. Sudbury (MA): Jones and Bartlett Publishers; 2009. p. 26.

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