Do I need an x-ray??? Nine times out of ten the answer is NO!!!
This is easily one of the most common questions I have encountered in my practice. Over time, we have been lead to believe that an x-ray is an important and vital tool when it comes to the diagnosis of injuries. What we have learned is that this is not necessarily the case for the majority of injuries.
X-Rays primary goal is to assess your bones and do not/rarely show any soft-tissue findings. They also tend to show signs of joint degeneration, which can be completely normal considering age and in most cases asymptomatic. Research shows that the majority of people >40-years old show multiple signs of degeneration in joints of their body but lead healthy, pain-free lives.
What this means is that just because your x-ray might show some degeneration/arthritic changes that it is rare that this is a significant finding that will affect your pain and/or overall health.
Generally, these are the people who might (depending on a carefully history and physical examination) need an x-ray:
Trauma (ie. fall, hit, bump)
Not getting better after being monitored/treated
Injury/pain getting worse over time
Acute (recent onset) swelling/redness of known or unknown origin
As you can now tell, most people do not fall into those above categories. Clinical practice guidelines and evidence-based medicine suggest clinicians show restraint and caution when sending their patients for an x-ray as they are grossly over-prescribed and unnecessary in vast majority of cases. The Ottawa Ankle and Knee rules are great examples of how the research is influencing clinicians to make better decisions on when to prescribe x-rays to their patients.
In my personal experience, even when people fall into the above mentioned categories it is still rare that the x-rays show any significant findings that change the treatment plan. In most cases they are used to rule out certain things (rather than rule them in).
My advice, be wary of practitioners who are quick to x-ray (especially if you do not fall into one of the above mentioned categories); the radiation dose from the x-ray, although safe and minimal, is still unnecessary and as detailed above, rarely contributes to the plan of management. Be even more careful if words like “degeneration” or “arthritis” are being used to intimidate/scare you, especially when it is coupled with the request of needing multiple treatments to fix.
A good practitioner will carefully assess (with a through history and examination) and educate you on whether you actually need to get an x-ray or not. In addition to this, they will responsibly go over the x-ray findings with you to ensure you can make the most informed and educated decisions regarding your care to ensure a true patient-centered doctor/patient relationship.
Written by Dr. Alim Kara BSc, DC