Why Get Spinal X-Rays When Visiting A Chiropractor?

By Dr. Philip Cordova

August 2, 2018

I don’t want x-rays,” the new patient scheduling on the phone tells the front desk staff. This is a conversation we have regularly with patients when they schedule, but one that is most often being determined by cost and not by need. We see medical offices, chiropractic offices, and hospitals charge a ton for x-rays but that’s not a good factor in deciding if you need one or not.

Some people are surprised with how little x-rays really cost these days. Insurance typically reimburses us no more than $50 per area x-rayed, so that’s all we charge for our cash patients as well. We do see charges as high as $300 or more for routine x-rays, so I can understand why patients are hesitant in the up front cost. However, you have to be safe when it comes to your spine. You can’t simultaneously wonder if chiropractic is safe and then stop the doctor from utilizing an easily accessible test to make sure you’re good to go.

Not all patients need x-rays

Not all patients must have spinal x-rays before they are adjusted, and this is a source of debate even amongst chiropractors. But every time I start to think that “maybe we don’t need x-rays,” in comes a patient that surprises us with what we find. We recently found an old fracture on the back of a patient’s vertebra, right where the neck connects to the mid back. She was having pain when putting a barbell across her back when working out. Think that might cause some pain? There’s no way we would have found it without an x-ray.

Let’s talk about what we’re looking for and why we need x-rays…

X-rays are taken after trauma…

Been in a car accident? It’s a good idea to get some x-rays in most cases, especially of the neck. You’re looking for fractures. Some people mistakenly believe that a broken bone would be immediately felt by the patient. You can have a hairline fracture, where everything’s in place and you’ll likely heal fine… but you don’t want a chiropractor putting pressure into that area.

You can also have a compression fracture, where it appears that the vertebra is collapsing on itself. This is also an area to be avoided and one that you’ll need to keep an eye on. Not all spinal traumas require an x-ray, but we will ask a lot of questions about the type of trauma you had and will do an examination before ordering a radiographic examination.

X-rays are taken if you’re over 40…

I’m over 40 and have had this talk with multiple healthcare providers. “Now that you’re over 40…” is a common phrase because so much starts to change when the doctor evaluates you for any type of condition. There are plenty of conditions that just don’t show up in people under 40 with the same frequency as those over 40. Like cancer. That’s the big one. There’s a specific type of cancer, called metastatic cancer that was drilled into our heads in school. I came out of school assuming that I would see it in about 50% of my patients. Thankfully, we’ve only found it twice in 21 years of practice.

Metastatic cancer means your cancer has spread. It can spread to the spine and the bones. You definitely don’t want a chiropractor pushing into a compromised area. Cancer in the bones means weaker bones and bones that can easily fracture. The last thing we want is to make anything worse. A quick x-ray let’s us know that you’re clear to get adjusted. Low back pain can be caused by a lot of different conditions, and pathology (cancer) is one of them.

X-rays are taken to be safe…

Have you heard of a condition called spondylolisthesis? Far more common than I would like, but it involves a vertebra sliding forward over the vertebra below it. They have different “grades” of this condition, based on how far forward that bone has slipped out place. Guess what you don’t want to do to a patient that has this problem? That’s right, push it more forward. I had a patient who’s brother-in-law was seeing a patient for years and didn’t have x-rays. One day, a push into that area just pushed it too far and severe pain and problems followed. It’s a good idea to know if you have this, and x-ray is the only way.

X-rays are taken for proper spinal assessment…

“How long will it take me to get better?” That’s a tough question and one that is difficult to answer without an x-ray. If two patients are standing side-by-side, you don’t really know which one has the worse spinal degeneration. Spinal degeneration, also called osteoarthritis, is a strong indicator as to how long you’ve had the problem (not just the symptom).

Even if the symptoms started last week, seeing bone spurs, narrowing of discs, and rough end plates makes it clear that this is not a new problem. A chronic problem can take longer to recover from than a new one.

We also take measurements and “listings” to figure out how we will adjust you. A listing is an indicator as to where in your spine you’re misaligned and specifically which direction so we know which direction and which bones will be adjusted. We also use manual palpation (feeling your spine with our hands), but x-rays are very helpful in helping us determine the primary misalignment and even globally how everything fits together.


Not all patients require x-rays. That’s a decision that will be made by your chiropractor after your initial consultation and examination. Just as it’s not really in your best interest to say “I don’t want x-rays” before the doctor has had a chance to check you out, we can’t promise we won’t need x-rays with you over the phone. We will always do what’s safest for you and explain everything up front.

If after everything is explained, we hope it’s clear why x-rays were or were not needed for your particular case.

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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