Why X-rays May Not Be Taken On Our New Patients

Isn't it dangerous to not have x-rays? Not according to research & healthcare professionals 

We have patients ask us all of the time, "Don't you need to take x-rays on me? My other chiropractors always did."

Having been in the chiropractic field for over 20 years, I absolutely understand the question. We were taught in school to take x-rays on everyone that comes in the doors. It was important so that we could make sure that we don't inadvertently cause any damage to our patients by working on something that had more issues than we expected. Things like cancer, subtle fractures, or something of that nature. 

The great news is that since I graduated from chiropractic school, more and more research has come out. New research turns into updated guidelines and recommendations. That's what research is for in the first place, right? To update our knowledge base and potential change and improve the way we do things. Well, that's the case here for x-rays and advanced imaging. 

First, there is solid research showing that when we take unnecessary x-rays, the findings many times are meaningless. Trust me, we can find SOMETHING on any and every x-rays taken. These findings are typically meaningless. However, highlighting them and focusing on them can, in the eyes of the patients, be scary and concerning. Patients tend to catastrophize these meaningless findings thinking they are somehow broken, fragile, weak, or not normal. Not only that, they may also start to back away from activity because they're afraid of doing more damage. More damage to something that wasn't a problem to start with and should have never been mentioned in the first place. 

When people avoid activity to prevent more harm or damage (even though that is perceived and not real), they become more sedentary and decondition. Becoming sedentary leads to more deeper chronic pain, depressions, anxiety, and sleep issues just to name a few things. 

Understanding all of this, then we know that it can be just as dangerous to take x-rays and, either puposefully or unintentionally, convince a patient they're broken as it would be to not take x-rays. 

Fortunately, A LOT of research work has been done on this issue and in more recent years, new guidelines emerged helping us providers to determine when x-rays are appropriate and when they are not. To be clear, some providers simply were taught every single patient should have x-rays regardless. Some just feel better knowing the specific of every single thing going on with the bones in a person before they treat. I get it and certainly don't condemn these providers. We have to run our clinics in the best way we see fit and that should be respected. Especially when we are talking about x-rays. 

With that being said, let's talk about who needs x-rays and imaging and who does not. These recommendations are called Choosing Wisely and are endorsed by the American Chiropractic Association. When RED FLAGS are present, x-rays are indicated. 



  1. The patient is less than 20 years old or older than 50 years old

  2. If the pain was caused by traumatic onset, fall, or accident

  3. If the patient has a history of cancer

  4. If the patient is having pain at night

  5. If the patient is running a fever

  6. If the patient is experiencing unexplained weight loss

  7. If the patient has pain at rest and cannot find a comfortable position

  8. If the patient has immune suppression such as corticosteroid use

  9. If the patient has had a recent infection

  10. If the patient has a generalized systemic disease like diabetes

  11. If the patient had failure of 4 weeks of conservative care. Which also means if you been doing PT or chiropractic or anything else conservative for 4 weeks with no relief or improvement and no recommendations for x-rays or MRIs, you as a patient should be either requesting them yourself or finding a different provider. It's common to hear of patients going to a provider for 3-4 months with no improvement. This should not be happening. 

  12. If the patient has Cauda Equina. This is damage to the central nervous system that can typically cause saddle anesthesia and/or bowel or bladder dysfunction. This is an emergency. 

  13. If the patient has motor weakness in the lower limbs. Meaning, they can't get on their tip toes and take a few steps or cannot get on their heels and take a few steps. I would also have them try a half squat. If they can't perform these simple functions, they need imaging. 

  14. This last one is a biggie - DO NOT USE REPEATED X-RAYS IN AN ATTEMPT TO PROVE TREATMENT EFFECTIVENESS. This puts the patient at risk of increased exposure to radiation. Radiation that is simply unnecessary. 


So there you have it. When these red flags are not present in our patients, then we do not do x-rays on them. In fact, we don't even have an x-ray machine here in our clinic and our patients tend to be very appreciative of the fact that they don't have to go get x-rays simply because they slept weird and woke up with a sore neck. This is why we are typically able to do an exam and treat all on the same day on the first appointment. This also tends to make our patients' very first appointments FAST AND EFFICIENT.

Patients REALLY love that part!

Most of our new patient appointments can typically happen within 48 hours of your call unless we're up against the weekend. But they do tend to fill up fast.

We'd love to help you get out of pain and back into your life. If we can help you, just call us at 806-355-3000 and we'll get you on the schedule as soon as possible. 



Dr. Jeff Williams, DC, FIANM, DABFP is double Board Certified as a Fellow in Neuromusculoskeletal Medicine and Orthopedics as well as a Diplomate of the American Board of Forensic Professionals, and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (https://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com.

Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020 & 2021. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Medical at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.  


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Jeff S Williams, DC, FIANM, DABFP

Jeff S Williams, DC, FIANM, DABFP


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