“Understanding What X-Rays Can (and Can’t) Tell Us About Pain”

How We Thoughtfully Use Spinal Imaging—and Why a Thorough Exam Comes First

If you’re dealing with back pain, neck pain, or headaches, it’s common to assume that an X-ray is needed to figure out what’s wrong. Many patients ask, “Don’t you need an X-ray to see what’s out of alignment?”

At Marathon Spine & Wellness, we take a thoughtful, patient-centered, and evidence-based approach to spine care—one that emphasizes time, attention, and clinical reasoning first.

Current research helps guide us on when imaging adds value—and when it does not change outcomes—allowing us to tailor care to each individual rather than defaulting to a one-size-fits-all approach. In fact, major clinical guidelines recommend against routine or repeat spinal X-rays for most cases of musculoskeletal pain.

This blog explains why we don’t regularly take spinal X-rays, when imaging is appropriate, and how we accurately diagnose and treat spine-related pain without exposing patients to unnecessary radiation.

What the Research Says—and How We Apply It Clinically

A comprehensive review published in Chiropractic & Manual Therapies examined the clinical value of routine spinal radiographs ordered by chiropractors. The authors concluded:

Routine or repeat spinal X-rays do not improve clinical outcomes or provide meaningful benefit for patients when red flags are absent.

Because X-rays use ionizing radiation, the researchers emphasize using imaging when it meaningfully informs diagnosis or alters the treatment plan—a principle we follow closely in our office.

This conclusion aligns with guidelines from:

• Primary care physicians

• Orthopedic specialists

• Physical therapists

• Evidence-based chiropractic organizations

In short: More imaging does not equal better care.

Understanding What X-Rays Can (and Can’t) Tell Us About Pain

X-Rays Show Bones—Not Pain

X-rays are excellent at detecting:

• Fractures

• Severe joint degeneration

• Advanced structural changes

But most spinal pain comes from soft tissues and functional issues, including:

• Muscle and tendon overload

• Ligament strain

• Disc irritation (without collapse)

• Nerve sensitivity

• Poor movement patterns

• Loss of spinal stability

These problems do not show up well—or at all—on X-ray.

An Important Analogy: Cancer and X-Rays

A useful comparison is metastatic disease. By the time cancer appears on an X-ray, it is often already advanced. Early-stage disease frequently goes undetected by plain imaging.

The same principle applies to spine pain:

• Significant symptoms can exist with “normal” imaging

• Mild or moderate dysfunction often isn’t visible

• Waiting for something to “show up” on X-ray delays proper care

In many cases, pain is best understood as a functional problem involving movement, load, and sensitivity—not simply a structural failure.

A Reassuring Truth: Pain Does Not Always Mean Damage

One of the biggest misconceptions we see in our Marathon-area patients is the belief that pain must mean something is “out of alignment” or “damaged.”

Research consistently shows:

• Many people with severe pain have minimal imaging findings

• Many people with arthritis, disc degeneration, or alignment changes have no pain at all

Imaging findings such as:

• Degenerative disc disease

• Arthritis

• Mild scoliosis

• Loss of disc height

are extremely common, especially as we age—and are often normal, non-painful changes.

When imaging findings are not placed in proper context, they can sometimes create unnecessary worry or confusion. We believe our role is to educate, reassure, and guide patients with clarity and confidence.

The Time and Care We Invest in Getting the Diagnosis Right

At Marathon Spine & Wellness, we pride ourselves on the art and science of diagnosis. We don’t rush visits, and we don’t rely on a single test or image to tell the whole story.

We use a thorough clinical evaluation that includes:

1. Detailed History

• When symptoms started

• What makes them better or worse

• Injury history

• Lifestyle and work demands

2. Orthopedic & Neurological Testing

• Strength

• Reflexes

• Sensation

• Nerve tension tests

3. Movement & Functional Assessment

• How your spine moves

• Where motion is restricted or excessive

• Stability and coordination

4. Red Flag Screening

We actively screen for signs that do require imaging, such as:

• Trauma or suspected fracture

• Progressive neurological loss

• Infection or inflammatory disease

• Suspicion of cancer

This comprehensive process allows us to accurately diagnose most cases of neck pain, back pain, sciatica, and headaches—and to determine whether imaging will truly add value for that individual patient.

When Imaging Plays an Important Role

We value imaging and absolutely order or refer for X-rays or advanced imaging when it is clinically justified and helps guide care.

Common reasons include:

• Significant trauma or accident

• Suspected fracture or instability

• Progressive weakness or numbness

• Failure to improve when imaging would guide next steps

This ensures imaging is used responsibly and effectively, not reflexively.

How Chiropractic Care Works in a Modern, Evidence-Based Practice

Modern chiropractic care is built on clinical examination, movement assessment, and neurological evaluation. While imaging can be helpful in certain situations, it is not required to:

• Identify movement restrictions

• Deliver safe adjustments

• Improve pain and function

Chiropractors are trained to assess joint motion, muscle tone, and neurological function through hands-on evaluation—not by measuring lines on an X-ray.

Our Commitment to Evidence-Based, Outcome-Focused Care in Marathon, WI

At Marathon Spine & Wellness, our goal is simple:

✔ Spend meaningful time with each patient

✔ Perform thorough, thoughtful examinations

✔ Base decisions on current research and clinical experience

✔ Create individualized, evidence-based treatment plans focused on outcomes patients care about

If imaging is helpful, we use it. If it’s not likely to improve care, we focus on the tools that will.

That’s not cutting corners—that’s good healthcare.

Looking for a Chiropractor in Marathon, WI?

If you’re dealing with back pain, neck pain, sciatica, or headaches and want an evidence-based approach, our office on Main Street in Marathon, Wisconsin is here to help.

📍 Marathon Spine & Wellness🌐 MarathonSpine.com

Schedule an evaluation and get answers—without unnecessary imaging.