X-rays are often used as a marketing tool to capitalise on peoples fear about their alignment & back pain.
Unfortunately there are still some health professionals who routinely x-ray people with back pain, this is despite the national governing bodies that represent chiropractic, medicine, physical therapy all strongly recommend against it. Studies show 90%-95% of back pain has no medical underlying cause, x-rays are notoriously bad at diagnosing the vast majority of back pain, and do more harm than good (see research below)
Some clinics will have on-site x-rays and rather than x-raying approximately 5% as clinically needed they will x-ray almost 100% of back pain sufferers with an obvious financial incentive for the clinic. With the cost of living today, I’m sure most people would rather not waste their hard earned money.
Most things seen on x-rays are just normal wear and tear giving the appearance of bones been misaligned or out. Only a snake oil treatment can claim that bones can magically be put back in (that were never out to begin with). You can take x-rays before treatments that supposedly realign the spine and after and they will be identical to each other. In my experience “fixing alignment” has more to do with justifying charging $80-$90 for a 10 minute treatment or excessive and expensive treatment plans that would otherwise only take 2 or 3 visits.
X-ray findings between people with back pain and without back pain are almost identical, they do not improve outcomes and do more harm than good!
Researchers found no evidence that the use of routine x-rays to assess the function or structure of the spine, improves clinical outcomes and benefits patients.
Researchers in another study concluded; in most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice. (Jenkins 2018)
Another study found routine imaging does not seem to improve clinical outcomes and exposes patients to unnecessary harms & the overuse of imaging also contributes to the high and growing costs associated with low back pain (Chou 2011).
A study published in American Journal of Neuroradiology found many imaging-based degenerative features (arthritis/misalignments) are likely part of normal aging and unassociated with pain. (Brinjiki 2018)
A 2019 study: Imaging in LBP may be associated with higher medical costs, increased healthcare utilization and more absence from work”. (Lemmers 2019)
Another study published in the British Medical Journal found “Imaging may do more harm than good when serious conditions are not suspected and is likely to prolong recovery in patients with non-specific low back pain”. (Hall 2021)
There are dozens of research done over two decades that all have similar findings.
How X-Rays Are Used.
Telling someone who has back pain that their spine is misaligned, arthritic/degenerated or a bone is out of place will only create unnecessary fear & may lead to prolonged recovery and a greater dependence on therapy. Below is what I encounter on a weekly basis from patients who have had unnecessary x-rays taken, I then have to go to great lengths educating and reassuring them their spine is not damaged.
1. Someone with simple back pain, usually muscular gets an x-ray
2. Report of findings: The practitioner tells the back pain sufferer they have lost the curve in their neck, too much curve in their low back, spine is misaligned, hips are out, spine has degenerated etc… Everyone gets told a variation of this.
3. The patient is also told this is what’s causing their pain (it’s not) and several months of treatment is needed some will offer to sell several months of treatment upfront at a reduced cost. With proper treatment most people only need two or three treatments before moving to a more active or self management phase.
4. Revolving door, 5-15 minute treatments with everyone getting the same cookie cutter treatment; two adjustments of the low back/hip, mid back and neck or a slight variation of this.
5. Symptomatic scheduling: 2 treatments a week for 4-6 weeks, one treatment a week for another 4 weeks. When I ask people who get this done why they kept going back when the results were so poor they would often tell me they believed it was normal and they were worried it would get worse if they didn’t.
The irony is the things that actually determine posture or where the body/bones are positioned in space are the muscles and are often seen as incidental.
W. Brinjikji,a P.H. Luetmer,a B. Comstock,b,c B.W. Bresnahan,c L.E. Chen,c R.A. Deyo,f S. Halabi,g J.A. Turner,d A.L. Avins,h,i K. James,c J.T. Wald,a D.F. Kallmes,a and J.G. Jarvikc,e Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations AJNR Am J Neuroradiol. 2015 Apr; 36(4): 811–816.
Roger Chou, Amir Qaseem, Douglas K Owens, Paul Shekelle, Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians Ann Intern Med 2011 Feb 1;154(3):181-9.
Amanda M Hall, Kris Aubrey-Bassler, Bradley Thorne, Chris G Maher. Do not routinely offer imaging for uncomplicated low back pain BMJ 2021 Feb 12;372:n291
Hazel J Jenkins , Aron S Downie, Craig S Moore , Simon D French Current evidence for spinal X-ray use in the chiropractic profession: a narrative review Chiropr Man Therap 2018 Nov.
G P G Lemmers, W van Lankveld, G P Westert, P J Van der Wees, J B Staal. Imaging versus no imaging for low back pain: a systematic review, measuring costs, healthcare utilization and absence from work. Eur Spine J. 2019 May;28(5):937-950.