Why We Don’t Send Everyone For X-Rays or Scans

The main reason is that it is just not necessary and the main problem is that if you do go for an x-ray and you are told “Of course it hurts, you have so much degeneration”, that can immediately make the pain feel worse because your brain will start to believe that you should have pain – because you have been told by ‘an expert’ that it will, so you DO!

Every time you do something, you have a picture in your head of how your spine looks and that can trigger something called Fear Avoidance Belief – and research shows that this changes parts of your brain such that you can develop chronic (long term) back pain purely because someone has caused you to fear that the pain will be worse if you do certain movements.


X-rays examine dense tissues such as bone with high levels of calcium. They are great for seeing fractures and bony injury.




Scans – either CT or MRI show bones too and show more subtle bone injuries but also the soft tissues such as cartilage (tissue that covers the bone in every joint), inflammation, nerve compression and spinal injuries, tendon or ligament ruptures, sprains and strains, disc tears, blood vessels and blood clots and small bony areas better than x-ray.



At the Avenue Clinic we always take a thorough case history of your problem and then examine you equally thoroughly before we touch you.







Particularly, the older we are, the more joint stiffness and aches and pains we experience – but should we be x-rayed before a chiropractor treats us to ‘see what is causing the pain’?

Of course, if we suspect that you have osteoporosis (thinning of the bones) or a fracture or on questioning you during the case history, something you tell us causes concern, then we would never treat you without images of your bones. Likewise, if you are not responding to treatment within the time frame we expect, we may choose to send you for scan or x-ray.

However, we do not often send many people for scans or x-rays because it is just not necessary.


Joint degeneration findings are too often interpreted as causes of pain and people can find themselves caught up in lengthy ‘treatment plans’ as a result of being shown the degeneration (which can look scary if you are not used to looking at images!), when these bony changes seen on films are really just part of the normal ageing process and an incidental finding.

You could be treated for years and the degeneration would always be there on the film, but the pain may well disappear with treatment.

We treat the patient, not the film findings!


This list shows the percentage of soft tissue injuries seen on MRI scans – and so many times they are just not giving rise to any pain!

In the neck (cervical spine)

Disc bulges are seen in 5 – 35% of MRI scans







In the low back (lumbar spine)

Disc degeneration is seen in 68 – 96% of MRI scans

Disc bulges are seen in 50 – 84% of MRI scans



In the hips

Tears in the surrounding tissues are seen in 54% of MRI scans

Cartilage problems are seen in 12% of MRI scans







In the shoulders

Tears in the surrounding tissues are seen in 55 – 72% of MRI scans







In the knees

Cartilage tears are seen in 43% of MRI scans

Meniscus tears are seen in 19% of MRI scans

Bony spurs are seen in 37% of MRI scans






We will always tell you what findings mean to you.

We always aim to treat you for as few treatments as possible.

If you do benefit from regular treatment then that is fine but we will never insist that you need it if you don’t.

We will never say that you have degeneration and you need a lengthy treatment ‘plan’ to keep you pain free. You are an individual and nobody knows how you may respond to treatment.

You may well feel huge benefit from coming to see one of us regularly because degeneration can cause pain and restriction and treatment can give you a lot of relief. However, this is up to you and how you feel you benefit from regular treatment.

We will always discuss with you your options and never make things sound worse than they are.

We will discuss MRI scan findings that you present with in the context of your pain, not just tell you that what you see on the scan is definitely why you are in pain.

We will always treat YOU – not the x-ray or scan you may have had.