Do I Need X-Rays or Not?

By Dr. Philip Cordova

November 8, 2021


This is the subject of much debate in the chiropractic community and I do understand why some chiropractors are against taking x-rays. Here’s why we do take x-rays on so many of our patients and you can decide for yourself.

We have patients that come to us that are dead set against x-rays. They say it’s due to concern about radiation, but I’ve found the most common issue is related to cost. They just want to get “cracked” as cheaply as possible, so why go through any extra steps?

In doing their research online, they will see conflicting statements from chiropractors saying they definitely need x-rays and some that say they definitely do not need x-rays. If the “do not need x-ray” crowd seems cheaper, that will be their preference and why they will get set on that route.

Here’s why some chiropractors do not recommend x-rays:

The primary goal of their x-ray recommendation is to rule out pathology or fracture.

That is how we’re taught in school. Did the patient have a recent trauma? No? Then they don’t need an x-ray because it’s highly unlikely anything is broken. Are they giving you any indications that they may have cancer or some other disease process? No? Then they don’t need x-rays.

Here’s an example of a “normal” x-ray.

They aren’t using the x-ray’s information beyond pathology or fracture.

If all you’re doing is looking at an x-ray for broken vertebrae or cancer, well you’re right. You don’t need an x-ray in most cases. It is very dangerous to try to adjust and area that is broken or may have a tumor, so that is a risk. It’s very rare that anyone comes to see us with either of these things.

In 25 years of practice, we’ve found cancer exactly 3 times. One patient had a grapefruit sized tumor in his hip. He had previous x-rays of his lower back from his MD, but none of them went low enough to see the tumor. We did not adjust that patient and were extremely grateful we had that x-ray.

As for broken bones, we do find spondylolisthesis on a regular basis. This is when a part of the spine has fractured, making the vertebra more likely to slip forward and cause further issues. There’s no way to find this without x-ray. Adjusting on these bones is not recommended and could cause further issues. Still, we find patients that have “gone to chiropractors for years” without issue and they had no idea they had that condition.

If nothing’s likely broken and there’s a slim to zero chance you have cancer, do you really need an x-ray?

X-ray machines, maintenance, and reading x-rays increases cost and risk.

X-ray machines are not cheap. Not only do you have to pay for the machine, you have to add lead to your walls, and you’ll be inspected periodically by the Department of Health (usually without notice). You have to had radiation detectors in your office for years to make sure all of the specifications not only kept your patients safe, but to make sure no radiation got to the staff areas either.

You’re also now responsible for reading all of the x-rays to make sure there aren’t any fractures or pathology. The liability for the reading of the x-rays and the report now fall on you. You also now must maintain all the x-ray records for years. None of this is free, and it increases the amount of work you have to do. If your patients don’t need x-rays, why take this on?

Here’s why some patients do not want x-rays:

X-rays are so expensive, I don’t need them.

My first question is “how much do they cost?” Always, the answer is “I don’t know.” They have been to emergency rooms and had x-rays that cost $500 or more for one area of the spine. “You want to check more than one area? I don’t want to spend $1,000 just to get my spine adjusted!”

Most insurance plans will pay around $30 – $40 per area of the spine being x-rayed. A full-spine x-ray series (3 areas of the spine) in our office costs $100 without insurance. Yes, we charge for x-rays. We do a lot of work on our x-rays, which you will see below. We take the x-ray, read the x-ray, create a report, and perform additional analysis… and now we must store that x-ray for you for years. I think it’s a pretty fair trade.

“I don’t have time for them, I just want to get adjusted.

I would argue that not taking x-rays will cost you more time and money in the long run. If your goal is to get “cracked,” then you’re right, you don’t need x-rays. There are plenty of offices that can make your spine pop and crack and you will feel great afterwards… but how do you know it was what you needed?

For years, I adjusted my wife a particular way. The left side of her pelvis needed to be adjusted on a regular basis. Following her adjustment, she would feel better for a little while, but then the symptoms would eventually return. I had been adjusting her since chiropractic school. For years she got adjusted the same way.

It finally occurred to us that there had to be more going on. We took new x-rays, but we still weren’t doing the type of analysis we do now. Everything looked “normal” on x-rays so we continued down that same path. When the same adjustment no longer helped, we took a different approach. We did a more thorough line analysis (not something typically taught in chiropractic school, more specific to a chiropractic technique called Gonstead) and came to the conclusion that we were adjusting her pelvis the wrong way.

We were making the misalignment worse, not better. Later, we learned about leg length deficiency and discovered that’s why her pelvis gave us the impression it had moved the other way. Once we applied this to our patients, we found the results were so much better we couldn’t go back to the old way of doing things.

The right x-ray analysis leads to a better adjustment, which will then require fewer adjustments. This saves you time and money. (We can also perform a full-spine x-ray series in about 10 minutes, so you have time. It’s the analysis that takes longer, but that doesn’t affect your time in the office.)

Here’s why we recommend x-rays in most cases:

Personalized and consistent care:

As discussed above, we want to be very clear about which part of your spine needs to be adjusted and in which direction. For us, it’s not about how many bones we can pop, it’s about getting the ones that need it and being consistent about it.

Even though you have your primary doctor in our office, there are occasions when that doctor is on vacation or isn’t there when you are. Your adjusting notes are a part of your file and every doctor has access to see which parts of the spine are being adjusted. This allows for consistency between doctors.

Every chiropractor I know has had a moment when the patient comes back in and says something like, “I don’t know what you did last time, doc, but it really helped. Do that again!” Imagine the dread that comes over the doctor when they think, “What did I do last time?” Consistency improves results and we want that for all of our patients.

Here’s what our x-ray analysis looks like (same x-ray as above, but with lines):

Safe and effective care.

Yes, it’s very rare that a patient has a broken spine or a cancerous tumor, but it’s not impossible. In addition to spondylolisthesis, we have patients that have congenital fusions (two vertebrae grew together naturally, forming one bone), missing vertebrae (they were born without one), spinal surgeries they forgot to mention (“I didn’t realize they put screws in my spine!”), and degenerative changes so bad they had to admit that the problem didn’t just start “this morning.”

We can adjust just about everyone, but we’ve found just about everyone needs some special attention on how a vertebra is adjusted or maybe a couple that need to be avoided. We can help you get great results and stop neck and back pain, but going in blind really isn’t the best idea for good long-term results.

Trackable results.

After a new patient starts care, we take a lot of measurements. We do periodic re-exams to document subjective and objective improvement. Then at the end of the patient’s care plan, we take a couple of follow up x-rays and re-measure everything. What’s improved? Is there anything we need to differently? What should the patient’s next steps be?

Since we have before and after x-rays, we can see how well you’ve done and make any tweaks to your care plan that are needed. Some parts of the analysis will be directly related to how you’re being adjusted, while other parts will only improve if you’re following your home care instructions. Regardless, we can track the results and make recommendations from there.

Do I need x-rays or not?

I’m going to say you likely need x-rays before starting chiropractic care. We do not x-ray women that are pregnant or children (in most cases). However, just about everyone else would benefit from at least an initial set of x-rays to see what’s happening with their spine.

There are plenty of chiropractic offices that will not recommend that you get x-rays. You don’t have to have them to get adjusted and feel some initial progress. Chiropractic is awesome and you can still see improvement without taking x-rays.

However, that’s not how we would want our family treated and that’s not how we will treat our patients. We firmly believe in a consultation, examination, and any necessary x-rays (with analysis) before starting any chiropractic care.

We also believe in giving our patients a plan of action. We will give you recommendations on number of visits and any additional services we think will help you. We won’t say “come back when you think you need to get adjusted again” because we think you came to see us for our help and our professional recommendations.

It’s still up to you when you return, but you’ll at least know what we recommend. We want chiropractic to work for you in both the short-term and long-term. We believe gathering information (x-rays) and properly analyzing that information goes a long way in making that happen.

Dr. Philip Cordova

About the author

Dr. Philip Cordova is a chiropractor in Houston, Texas. He grew up in Phoenix, Arizona and decided to become a chiropractor after hurting his back as a teenager and getting help from chiropractic care. He is speaker on health & posture. Click Here To Read His Full Bio

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