Do I need a back X-ray?

Back pain can be very severe. Many patients are convinced that the intensity of their pain means the cause is a major structural failure of the spine. Phrases such as "dislocated vertebrae", "bone out of place" "slipped disc" and "crushed nerve" are often used. It is natural in these circumstances to think that an X-ray of the spine will reveal the nature of the damage and what treatment is required.

For many years it was a routine practice to send patients suffering from back pain for X-ray. Research now shows that X-rays rarely help in diagnosis or treatment of low back pain. X-rays can only detect damage to bone in the spine. Relevant bony defects are rarely found. Correlation between X-ray findings and the degree of pain experienced is often poor. The reason is that soft tissue damage is invisible on X-ray and most back pain arises from muscle, disc and nerve tissue. For the great majority of patients with back pain an X-ray is not necessary or useful.

Because of its limitations Osteopaths do not need to see an X-ray before treating a patient. Thorough physical examination and case history taking allow an Osteopath to assess whether a patient is suitable for treatment. If medical imaging is required either due to findings in the initial examination or due to concerns in the response to treatment your Osteopath will refer you to a doctor. The most frequently useful technique is Magnetic Resonance Imaging or MRI. Unlike X-ray this does show soft tissue such as intervertebral discs and muscle. It also has the advantage of not exposing the body to ionising radiation and has no known side effects. Another method is Computer Axial Tomography or CT scan. This is like a 3D x-ray and is useful if there is malformation or trauma to the spine.