“Why is There an X-Ray Machine in My Chiropractor’s Office?”

 “Why is There an X-Ray Machine in My Chiropractor’s Office?”

If you’ve never been to a chiropractor before, you probably picture a comfy treatment table, a friendly smile at reception, and maybe some relaxing music in the background. What you might not expect to see is… an X-ray machine.

For some of you reading this blog post, you have already had an amazing experience at a chiropractic clinic, but x-rays weren’t offered at that clinic. The truth is that not all chiropractic clinics utilise diagnostic imaging for a multitude of reasons. They are expensive to purchase and maintain, they require specialist-controlled areas with lead lined walls, and they take up rather a large amount of space. However, in some chiropractic clinics, X-rays are a valuable tool that helps your chiropractor understand exactly what’s going on inside your body. We will discuss the benefits of utilising x-rays in chiropractic clinical practice and why we use them here at Spriggs Chiropractic.

Before we go any further and to make sure this statement is made at the start of this blog post, rather than somewhere at the bottom where is easily missed or ignored. X-rays are not for everyone, and not all patients who come to Spriggs Chiropractic are x-rayed as a standard. Most patients present with simple, non-specific episodes of low back or neck pain that does not require any diagnostic imaging before commencing treatment. However, on some occasions, x-rays are essential before commencing treatment^1–3. This is why Spriggs Chiropractic’s x-ray machine is available for referrals from clinicians who do not offer x-rays in their clinic. We receive several referrals every month from local clinicians whose patients’ need to be x-rayed before treatment can commence. If you are a clinician looking for x-ray services, here is the link to our website page just in case this is helpful for your practice.

Why Take X-rays?

There are many reasons why a chiropractor might need x-rays before commencing care. Many patients come to Spriggs Chiropractic because they have failed to respond to care elsewhere. Some patients have been to see other clinicians and medical professionals for their complaint but have not responded as expected. Typically, this is not because the treating clinician was not good at what they do (manual therapy or otherwise), and as I explain to patients and students alike:

“There might be an underlying reason why you haven’t responded to care so far.”

Imagine you’re trying to fix a car, but you can’t open the bonnet. You can listen to the engine, check the tyres, maybe even take it for a spin — but without looking inside, you’re taking an educated guess. Your spine works the same way. Chiropractors are experts at feeling how your joints move and spotting posture changes from the outside. But sometimes, they need to “pop the hood” before they “pop your back” — and that’s where an X-ray comes in.

Not all postural distortions can be observed externally¹. As Oakley and colleagues point out in their paper, there are several spinal displacements and distortions that appear identical during a posture assessment when assessing a patient. The underlying cause is only revealed once an x-ray has been obtained¹.

X-rays give chiropractors a detailed look at your bones, joints, and posture from the inside. This isn’t just about confirming a diagnosis — it’s about understanding your unique structure or spinal dysfunction so care can be tailored to you. We have two recent patients where their previous MRI scans were “normal”, however, with x-ray analysis of their spines, the reason for their neck pain was found to be due to abnormal motion of several segments of their necks. The images obtained in the clinic altered the patient’s treatment plans and the patients made a great recovery.

I’m not joking when I say this, I once had a chiropractor say to me “I don’t use x-rays in my clinic because it is out-dated technology…” – Well, if this were the case, why are x-rays still used as the first-line diagnostic test for trauma/injury assessment, assessment and staging of arthritis, chest and abdominal assessment for disease in medical practice? A&E and radiology departments all over the world use x-rays all day, every day. Why would it still be used at all in medicine, if it such “out-dated technology”?

I’ll tell you why, because they are cheap, accessible and perfectly capable of assessing patients for the most common signs of many kinds of diseases and conditions patients present with. The very notion that chiropractors don’t need to utilise diagnostic imaging to assess at least some of their patients before commencing treatment is beyond comprehension. However, there appears to be some in the profession who think x-rays are “outed technology” or simply have no use in chiropractic clinical practice. This blog is not necessarily here to change the minds of those who have the opposing opinion to mine. This blog is here to demonstrate to patients that some chiropractors utilise x-rays to aid in the diagnosis and management of their pain conditions and do so with your best interests at heart.

Modern machines take a fraction of a second to produce a high-quality image of patients’ anatomy and deliver a tiny, perfectly safe dose of radiation to the patients. In fact, many researchers in the published, peer reviewed literature that state the radiation dose to the patient poses no risk at all^1,4–10.

As one of only a handful of chiropractors in the UK with advanced qualifications in this field, and teaching diagnostic imaging at two UK universities, I feel it my responsibility to make sure this topic is covered in detail. I am passionate about this topic and freely admit that I am biased towards the use of imaging in Chiropractic. We all have our biases, and I admit this is mine, however, I am pro the appropriate use of imaging in Chiropractic, whatever this truly means.

The Process

It is important to note that before x-rays of your spine, or any other body part are obtained at the clinic, your chiropractor will take your case history and perform a physical examination of your presenting complaint. If, at the end of this process, the chiropractic finds clear clinician reasoning that justify and support the use of x-rays, then we obtain these images on the day of your consultation. The fact they are obtained same day as your consultation at the clinic means there is no need to wait for a referral to a hospital saving a lot of time for you, the patient.

When I discuss this topic with patients, fellow clinicians, and when I am teaching students, I explain that I am a patient advocate for diagnostic imaging. Meaning that I believe that your voice as a patient must be heard when it comes to your healthcare requirements and expectations. I have spoken to clinicians who believe that x-rays aren’t necessary (which we will discuss in detail in this blog post) and that the patient should not be given the choice. What this means is that some clinicians think they know better, and therefore they remove the patient from the decision-making process. Personally, I take the position that, your voice and choice matters, so you should be involved in the decision-making process. If the clinical justification simply isn’t there, and therefore x-rays aren’t needed in your situation, this needs to be explained to you, so you understand why this is case, so a joint decision is made between you and your clinician.

Why Would a Chiropractor Take X-Rays?

Here are a few reasons your chiropractor might recommend X-rays:

• Identifying underlying conditions – X-rays can reveal fractures, arthritis, scoliosis, or degenerative changes that may be contributing to your symptoms.
• Spotting problem areas early – In some cases, changes in bone alignment or joint space can be seen before symptoms worsen, helping prevent further problems.
• Finding contraindications to care – I have never taken an x-ray expecting to find something serious, but I have found them on several occasions in my career.
• Guiding safe treatment – If there’s an issue that could make certain adjustments risky, X-rays help your chiropractor know exactly how to proceed safely. In our study published in 2022 found that a staggering 30% of patients presenting to Spriggs Chiropractic were unable to receive spinal manipulation due to underlying health issues and structural changes within their spine³.

Safety First (and Second, and Third)

Our study isn’t the only one, there are several published studies that show that x-rays alter the treatment options for patients presenting to Chiropractors with aches and pains^3,11–13. Therefore, Chiropractors can use spinal x-rays to develop a tailored care plan for their patients and reduce risks of unnecessary complications and harm.

Some people are understandably concerned about radiation exposure from X-rays. The good news is that modern chiropractic clinics use digital X-ray systems that produce high-quality images with very low radiation doses. Our understanding of radiation effects on biological tissues is changing rapidly¹⁰ with more evidence being published year-upon-year.

Why Patients Often Love Seeing Their X-Rays

A significant part of my job is making sure the patient understands their condition. This is where x-rays can be invaluable for patients. Understanding your condition is empowering, as you will know if you it is safe to continue exercising without making your condition worse. Or if you need to alter your exercises or lifestyle to help manage your condition. Patient education is critically important to their recovery, and when x-rays are clinically necessary, educating patients becomes much easier and meaningful.

If you have failed to respond to manual therapies or conventional treatments for your back or neck pain, call us on 01635 43238 or email hello@spriggschiropractic.co.uk to book your initial consultation. See if we can get the route cause of your pain!

By Mark Spriggs DC, MChiro, MSc, PGCert, FRCC

References:

1. Oakley PA, Cuttler JM, Harrison DE. X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation : Radiography Increases Benefits and Reduces Risks. 2018;(March):0-6. doi:10.1177/1559325818781437
2. Oakley PA, Haas JW, Harrison DE. The Rationale and Safety of Routine Imaging in Rehabilitative Spine Care : Delayed Radiographs for Patients Presenting With Spine Disorders is Debatable. 2025;23(3):1-18. doi:10.1177/15593258251374411
3. Spriggs M, Foulkes D. How Frequently Do Lateral Cervical Spine Radiographs Alter Treatment Options In Chiropractic Practice? J Contemp Chiropr. 2022;5(28):57-75.
4. Oakley PA, Harrison DE. Are Continued Efforts to Reduce Radiation Exposures from X-Rays Warranted? Dose-Response. 2021;19(1). doi:10.1177/1559325821995653
5. Oakley PA, Navid Ehsani N, Harrison DE. 5 Reasons Why Scoliosis X-Rays Are Not Harmful. Dose-Response. 2020;18(3). doi:10.1177/1559325820957797
6. Oakley P. Radiogenic Cancer Risks from Chiropractic X- rays are Zero: 10 Reasons to Take Routine Radiographs in Clinical Practice Best Practices Radiogenic Cancer Risks from Chiropractic X-rays are Zero : 10 Reasons to Take Routine Radiographs in Clinical Practice. Ann Vertebr Subluxation Res. 2018;2018(March):48-56. https://www.vertebralsubluxationresearch.com/2018/03/10/radiogenic-cancer-risks-from-chiropractic-x-rays-are-zero-10-reasons-to-take-routine-radiographs-in-clinical-practice/
7. Oakley PA, Harrison DE. X-ray Hesitancy—Response to Jargin and Sohrabi. Dose-Response. 2020;18(4):10-12. doi:10.1177/1559325820982425
8. Oakley P, Harrison D, Harrison D, Haas J. On “phantom risks” associated with diagnostic ionizing radiation: evidence in support of revising radiography standards and regulations in chiropractic. J Can Chiropr Assoc. 2005;49(4):264-269. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1840021&tool=pmcentrez&rendertype=abstract
9. Oakley PA, Harrison DE. Death of the ALARA Radiation Protection Principle as Used in the Medical Sector. Dose-Response. 2020;18(2). doi:10.1177/1559325820921641
10. Cuttler JM. Evidence of Dose Threshold for Radiation-Induced Leukemia: Absorbed Dose and Uncertainty. Dose-Response. 2019;17(1):1-2. doi:10.1177/1559325818820973
11. Beck RW, Holt KR, Fox MA, Hurtgen-Grace KL. Radiographic anomalies that may alter chiropractic intervention strategies found in a New Zealand population. J Manipulative Physiol Ther. 2004;27(9):554-559. doi:10.1016/j.jmpt.2004.10.008
12. Jenkins H, Xiaoming Z, Bull P. Prevalence of Congenital Anomalies Contraindicating Spinal Manipulative Therapy within a Chiropractic Patient Population. Chiropr J Aust. 2010;40(2):69-76.
13. Pryor M, McCoy M. Radiographic findings that may alter treatment identified on radiographs of patient receiving chiropractic care in a teaching clinic. J Chiropr Educ. 2006;27(9):554-559.