Do You Really Need an X-Ray Before Seeing a Chiropractor?
Introduction
If you’re considering chiropractic care for the first time, you may have heard some conflicting messages about the role of X-rays in treatment. Perhaps a friend insisted you must get imaging before your first visit, while another said their chiropractor never took X-rays at all. With so much contradictory information out there, it’s no wonder many people feel confused and unsure about what to expect.
The truth is, while X-rays can be a valuable diagnostic tool in certain situations, they are not always necessary for safe, effective chiropractic care. In fact, many patients are encouraged to get imaging even when it may not be clinically indicated, exposing them to unnecessary radiation and potentially increasing healthcare costs.
So how do you know if you really need an X-ray before seeing a chiropractor? The answer is not always black and white, but there are some important guidelines and considerations that can help you make an informed decision.
The purpose of this blog post is to cut through the noise and provide clear, evidence-based information about the role of X-rays in chiropractic care. We’ll explore:
- When imaging is truly necessary
- What to make of common X-ray findings
- How a holistic, patient-centred approach can often be just as effective – without the added radiation exposure
By the end of this post, we hope you’ll feel empowered to advocate for your health and make informed choices about your care. Whether you decide to get an X-ray or not, the most important thing is that you feel confident and comfortable with your treatment plan. So let’s dive in and separate fact from fiction when it comes to chiropractic X-rays.
Understanding Normal Variants and Spinal Alignment in X-Ray Findings
What Are “Normal Variants”?
When looking at spinal X-rays, it’s important to understand that not every finding is a cause for concern. In fact, many of the things that might seem alarming at first glance are actually quite common and often don’t require any intervention. These are what we call “normal variants” – anatomical differences that fall within the broad range of what’s considered healthy.
One of the most common is so-called “Disc Degeneration”. As we age, it’s normal for the cushioning discs between our vertebrae to lose some of their hydration and height. This can show up on an X-ray as slightly narrowed disc spaces or small bone spurs. But despite the rather scary-sounding name, these changes are actually very common and normally don’t cause any symptoms.


It’s important to remember that X-ray findings don’t always correlate with symptoms. In other words, just because something looks a bit different on an X-ray doesn’t necessarily mean it’s the cause of your pain. A study published in the American Journal of Neuroradiology found that so-called “disc degeneration” was present in 37% of 20-year-olds with no symptoms. By age 80, that number jumped to 96%.
So if your X-ray report mentions some of these normal variants, don’t panic. It doesn’t automatically mean you have a serious problem that needs to be fixed. A skilled chiropractor will be able to correlate the X-ray findings with your unique symptoms and physical exam to determine if treatment is necessary.
Is “Perfect” Spinal Alignment Really Necessary?
Another common misconception is that everyone’s spine needs to be perfectly straight and aligned for optimal health. You might have seen X-ray images in a chiropractor’s office comparing a “normal” spine to one that’s slightly curved or misaligned, with the implication that the latter is a problem that needs to be corrected.
However, the truth is that there’s a wide range of normal variation in spinal alignment, and what’s considered “ideal” can differ from person to person based on factors like age, body type, and activity level. Research has shown that there’s no one “perfect” spinal curve that everyone should strive for.

In fact, blindly trying to force the spine into some arbitrary ideal alignment can sometimes be counterproductive. A 2014 study in the journal Chiropractic & Manual Therapies found that patients who received adjustments to correct “subluxations” (minor misalignments) had no better outcomes than those who didn’t.
So what does this mean for you as a patient? Essentially, it means that minor variations in your spinal alignment aren’t necessarily something to be feared or obsessed over. A good chiropractor will look at your alignment in the context of your overall function and symptoms, not just the X-ray image.

Rather than striving for some textbook ideal, the goal should be to help your spine move and function optimally for your unique body and lifestyle. Sometimes that might involve gently encouraging better alignment through adjustments, exercises, and postural changes. But other times, the best approach might be to leave well enough alone and focus on more relevant factors contributing to your pain or dysfunction.
The bottom line is that spinal alignment is just one piece of the puzzle when it comes to your overall health. It can be important (in some cases), but it’s not the only thing that matters. An experienced practitioner will take a holistic view of your case, considering alignment alongside other key factors like muscle balance, joint mobility, and lifestyle habits.
So if you’ve been told that your spine is “out of alignment” based on an X-ray, don’t automatically assume that means you need aggressive adjustments or long-term treatment plans. Ask questions, get a second opinion if needed, and look for a chiropractor who takes a balanced, patient centred approach to care. Your spine is unique, and your treatment plan should be too!
Current Guidelines on X-Ray Usage in Chiropractic Care
When Are X-Rays Really Needed?
The General Chiropractic Council (GCC) and the American College of Radiology (ACR) provide clear guidelines on when X-rays are necessary for chiropractic care. According to the GCC’s 2022 Diagnostic Imaging Guidance, chiropractors should use X-rays primarily:
- To rule out serious conditions (fracture, tumour, infection) in patients with red flags
- To assess specific conditions requiring imaging for diagnosis or management (scoliosis, spondylolisthesis)
X-rays may be warranted after traumatic injuries, when patients have neurological symptoms indicating a serious condition, or to monitor scoliosis progression in children and adolescents. They may also be considered when a patient’s history suggests possible metastatic disease.
However, even in these cases, more advanced imaging like MRI might be more suitable. Your chiropractor should discuss all options and alternative imaging methods before deciding on X-rays.
For uncomplicated back pain or common musculoskeletal issues, routine X-rays are generally not recommended. The ACR advises against imaging for acute low back pain without red flags, as it doesn’t improve outcomes and may lead to unnecessary treatments.
Chiropractors should make X-ray decisions based on a careful consideration of each patient’s unique case, including symptoms, medical history, and physical exam findings. They should explain their reasoning and address any concerns about the risks and benefits of imaging.
Minimizing Radiation Exposure in Chiropractic Care
What Are Gonad Shielding and Collimation?
While X-ray radiation is relatively low, it’s crucial to minimize exposure, especially for pregnant women or those with conditions increasing radiation sensitivity. A key safety practice known as “collimation” helps protect patients during X-rays. This is where radiographers use metal shutters called “collimators” to narrow the X-ray beam to the specific area of interest, minimizing the radiation dose and improving the quality of the image.
Proper collimation is essential for reducing radiation and improving image quality. If your X-rays show your entire body on either side of the spine, it likely means collimation wasn’t properly performed or was skipped entirely. While precise collimation can sometimes be difficult to determine, there should be evidence that it was at least attempted.

Patients should expect and request the highest safety standards for X-ray procedures. Ask your chiropractor or radiographer about their collimation practices. Furthermore, imaging should only be taken of the specific area your practitioner is concerned about. Taking X-rays of your entire spine is rarely warranted outside of rare cases like significant scoliosis.
Responsible providers prioritize patient safety and will gladly explain their protocols and discuss alternative imaging options like ultrasound or MRI if you have specific risk factors or preferences. They make your health and safety their top priority—not just in the imaging process but in every aspect of care.
But how can you tell if a chiropractor is truly following these best practices and prioritizing your well-being? Let’s explore some common red flags that can help you recognize poor X-ray practices.
Recognizing Poor X-Ray Practice

While the vast majority of chiropractors are ethical, patient-centred professionals who use X-rays only when clinically indicated, there are exceptions. In any profession, a small minority may prioritize profit over patient care. Unfortunately, in chiropractic, this can sometimes involve the misuse of X-rays to frighten patients into agreeing to unnecessary or overly aggressive treatment plans.
As a patient, it’s essential to be able to recognize these tactics so you can make fully informed decisions about your care. Here are some red flags to watch for:
- Routine full spine X-rays for every patient, regardless of their condition: Requiring extensive imaging without a clear clinical reason is not evidence-based and exposes patients to unnecessary radiation.
- Alarmist language to describe normal findings: Terms like “spinal decay” or “degeneration” may sound concerning but are often normal, age-related changes that don’t always require treatment.
- Pushing extended treatment plans or prepaid packages: Recommending long-term care without assessing a patient’s progress can indicate a one-size-fits-all approach.
- Claims about predicting future health problems based on alignment: While spinal alignment is an important factor, it’s only one piece of a much larger health puzzle.
If you’re concerned about how to find a chiropractor who prioritizes your health and practices ethically, we’ve created a detailed guide to help. Read our blog post on finding a good chiropractor to learn what to look for, the questions to ask, and the warning signs to avoid.
A reputable chiropractor will always explain their recommendations clearly and collaborate with you on a treatment plan tailored to your unique needs. If you’re feeling unsure about what to do next, know that you’re not alone—and there are patient-centred options available.
At our clinic, we take a completely different approach. Our Quadrant Analysis (QA) method ensures your care is not only ethical but also tailored to uncover the root causes of your pain, empowering you to make confident, informed decisions.
Empowering You on Your Health Journey with Quadrant Analysis (QA)

Our advanced Quadrant Analysis (QA) method is designed to uncover the root causes of your pain by systematically assessing your entire body and overall health—not just your spine. This holistic perspective allows us to create personalized treatment plans tailored to your unique needs, often without relying on unnecessary X-rays.
Through QA, we prioritize transparency and education, empowering you to understand your body better. We partner with you to:
- Identify the key factors contributing to your pain or dysfunction.
- Explore effective, non-invasive treatment options.
- Equip you with self-care techniques to maintain your progress long-term.
Unlike practices that rely heavily on imaging to guide care, our QA approach ensures that every recommendation is grounded in evidence, prioritizing your health and well-being above all else.
Take the Next Step
Your health is your most valuable asset, and making informed decisions is the key to protecting it. If you’re ready to experience the advantages of our patient-centred QA method first-hand, we invite you to:
- Book a Consultation: Schedule a complimentary 15-minute in-person consultation to discuss your concerns, ask questions, and explore your options—no pressure, no obligations. You can book online here or by calling our friendly reception team on 01732 742120
- Learn More About QA: Dive deeper into our unique approach by reading our in-depth article on Quadrant Analysis and discover how it can empower your health journey.
By partnering with a chiropractor who prioritizes safety, transparency, and personalized care, you can feel confident that you’re on the path to long-term wellness.