What to Expect
Do I Need an X-ray or MRI for Back Pain?
Reviewed by Dr. Dustin Dukart, DC
It feels backwards, but for most new back pain the evidence-based answer is: not right away, and often not at all. Here’s why — and the specific situations where imaging genuinely is the right call.
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Counterintuitive but well-supported: routine imaging in the first several weeks doesn’t improve outcomes for ordinary back pain, and often finds things — disc bulges, “arthritis” — that are extremely common in people with no pain at all. A hands-on exam guides treatment better than a scan for most new cases.
Why Guidelines Say to Wait
For typical low back pain without warning signs, the American College of Physicians and the Choosing Wisely campaign both recommend against routine imaging in the first several weeks. Two reasons: it doesn’t improve outcomes for ordinary back pain, and it very often finds things — disc bulges, degeneration, “arthritis” — that are extremely common in people without any pain at all. Seeing one of those on a report can make the problem feel more fragile and permanent than it is, and that alone can slow recovery.
When Imaging Is the Right Call
Imaging is appropriate — sometimes urgently — when the exam turns up a red flag, including:
- New leg weakness, saddle-area numbness, or any change in bladder or bowel control
- Significant trauma (a fall, a car crash), or a minor injury in someone with osteoporosis
- A history of cancer, unexplained weight loss, fever, or IV drug use
- Pain that is severe and unrelenting, clearly worse at night, or not improving at all over about six weeks of reasonable care
- Signs pointing to a specific condition a scan would change the treatment for
Part of a first visit here is a red-flag screening for exactly these — so that if a scan is warranted, you get referred for the right one, and if it isn’t, you’re not sent for a test that won’t help.
What Happens Instead
A hands-on orthopedic and neurological exam is what actually guides early treatment for most back pain — it tells us far more about what to do next than an image of a normal-for-your-age spine would. Here’s what a first visit looks like.
Trying to Decide About a Scan?
Most new patients are seen within a few days. Related: the low back pain page and when to see a chiropractor versus a doctor.
Book Your Visit → or call (612) 314-9482
References
- Qaseem A, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017. View source
- Choosing Wisely — Imaging tests for lower-back pain (American Academy of Family Physicians / American College of Radiology recommendations). View source
- Chou R, et al. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009. View source
