Chiropractic Routine New Patient X-Rays Are Not Necessary

The beauty and the downfall of chiropractic is that practitioners can choose how they want to practise as long as it falls within their scope of practise. This applies to all practitioners of the medical profession and not just chiropractors.

The College of Chiropractors of BC have removed routine x-rays from the scope of chiropractic in February 2021 due to lack of clinical evidence that it improves patient outcomes.

Some chiropractors are upset about this new regulation and went to the BC Supreme Court to have routine x-rays to be reinstated within scope of chiropractic. I can understand why these chiropractors are upset because in some chiropractic colleges taking and reading x-rays are a significant part of the curriculum. I believe accredited chiropractic colleges need to step up and update some aspects of the curriculum to match the current level of evidence.

When are x-rays deemed necessary for back pain?

According to Craig Liebenson, one of leading experts in back pain, provided the following for when x-rays are deemed necessary1 :

  • To rule out spinal fracture after significant trauma in a healthy patient
  • To rule out spinal fracture after minor trauma in a compromised patient
  • To rule out spinal instability after trauma
  • Evaluate hardware in a post-operative patient

Controversial justifications for taking x-rays for back pain:

  • To determine misalignments of the spine (this excludes monitoring idiopathic adolescent scoliosis).
  • To determine if degeneration is the cause of the back pain
    • Spinal osteoarthritis and degenerative disc disease does not correlate with the amount of back pain a patient experiences 2,3. What this means is that a patient with findings of severe osteoarthritis and disc degeneration is not likely to be the pain generator.


  1. Liebenson, C. (2020). Investigations in the Diagnostic Triage Process. In Rehabilitation of the spine: A patient-centered approach (pp. 212–213). essay, Wolters Kluwer.
  2. Rosen M. Back Pain. Report of a Clinical Standards Advisory Group on Back Pain. London, UK: Stationery Office; 1994.
  3. Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guidelines. No. 14. Rockville MD: Agency for Health Care Policy and Research; 1994. AHCPR publication 95-0642.

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