A lot of new patients ask us some version of the same question: “Will I need X-rays before you can treat me?” For most people, the answer is no. We don’t take X-rays in our office, and for the large majority of the neck pain, back pain, and headache patients we see, a careful history and hands-on exam tell us what we need to know.
Why most chiropractic patients don’t need X-rays
X-rays are good at showing bone: fractures, advanced arthritis, and some structural problems. They are not good at showing the muscles, joints, ligaments, and nerves that cause most everyday back and neck pain. They also tend to show “findings” that look alarming but are normal for your age, like disc wear, which plenty of people without any pain have too.
That’s why current guidelines advise against routine imaging. The American Chiropractic Association’s Choosing Wisely recommendations, for example, say clinicians should not order spinal imaging for new low back pain during the first six weeks unless there are warning signs. Several medical groups, including the American College of Physicians, make similar recommendations. Routine X-rays add cost and radiation exposure without improving how most patients do.
What we do instead
At your first visit, we take a detailed health history and do a hands-on exam: posture, range of motion, orthopedic and neurological tests, and pinpointing where your pain comes from. That tells us whether chiropractic care is a good fit and which treatment approach makes sense. You can read more in what to expect at your first chiropractic visit.
When imaging is the right call
Some situations do call for imaging, such as:
- A significant fall, car accident, or other trauma where a fracture is possible
- A history of cancer, unexplained weight loss, fever, or other signs of a more serious problem
- Numbness or weakness that is getting worse, or changes in bladder or bowel control
- Known or suspected osteoporosis
- Pain that isn’t improving as expected after several weeks of care
If your history or exam points to any of these, we’ll refer you to your primary care provider or an imaging center so you get the right test, and we’ll review the results with you before deciding on next steps.
Have X-rays or an MRI from somewhere else?
Bring them, or the report, to your appointment. Recent imaging from your doctor, an urgent care, or a previous provider can be helpful, and we’ll take it into account in your care plan.
Questions about whether you need imaging? Contact us or call 360-573-5500. You can also learn more about our chiropractors in Vancouver, WA.
