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Back Pain X-Ray

Primary Care surveys in the NHS tell us that an expectation people have when they are in pain is to be examined and part of the examination would be imaging. In the last few years it seems that science and public opinion have grown apart. Where the scientific community have moved away from imaging to ‘see’ what’s there in back pain to only taking imaging when a strong suspicion exists of there being pathology. As I wrote on my blog about ‘massive disc pain’ the evidence base shows a very poor correlation between degenerative signs on imaging and back pain in the general population. The work was published in 2014 (1). Even though the science says no need to image in 97% of cases of back and neck pain, public opinion or culture seems to be stayed in the idea that they are having something taken away from them if they are not x-rayed (2). A part of the MSK examination is missing or they are not receiving the Care they are entitled to which impacts on expectations of Care. It is in the expectation of Care that MSK symptoms can vary by c. 40% (3).

The question is to image or not to image…



There are still in place medical indications to take x-rays when a person has back pain. One example is when pathology is suspected (about 1- 3% of cases). Part of the initial triage a chiropractor goes through is to rule out serious suspicion of medical pathology. A chiropractor is trained to examine and assess to make medical referrals, however in the UK the NHS is, on the whole, not inclusive of Chiropractors. This fact does not detract from chiropractic education which provides chiropractors with advanced practise resources and knowledge in MSK medicine to look out for serious pathology.

Most people know chiropractors for muscle aches and joint pains. If that is you and you are thinking that you ‘need’ x-rays or other imaging then looking at the science you might be stayed in a public culture that will eventually turn. Science provides the evidence for this turn where the vast majority of back pain and neck pain episodes will not need imaging to complete a full examination of MSK concerns.




  1. Brinjikji P.H. et al (2014) Systematic Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Am J Neuroradiol 10.3174/ajnr.A4173
  2. Sharma S et al (2021) I Would Go to Him. Health Expectation 00 1-11
  3. Bialosky JE et al Individual Expectation: An overlooked but pertinent factor in the Treatment of Individuals Experiencing Low Back Pain
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