People often ask if x-rays are necessary to know how to treat their neck pain. In most instances, outside of some kind of physical trauma (i.e. a fall or car accident) or concern for serious health issue, the answer is 100% NO.

But doesn’t the provider need to know what is going on?

Well…here is the thing with x-rays – they only show a moment in time. Outside of serious pathology they DO NOT provide information on how to treat someone. Plus who is to say that picture of the neck didn’t look that way 6 months prior. As in when the person had NO pain or limitation whatsoever.

Here is the deal with x-rays. Anyone over the age of 40 is going to show some “change” on x-ray…it is called normal aging and has little to do with any pain or dysfunction. BUT, the moment someone knows their x-ray may look “not perfect” (again aging), they begin to worry. What might have been just a slight stiffness in the morning waking up now becomes a bigger issue. Why? Because they were told there is a “change” and that must be why they are stiff and now the brain and body start to respond negatively to relatively benign things in life.

Why then do so many doctors order them?

Great question. The answer…because patients expect doctors to have an answer. And if the doctor isn’t going to perform a THOROUGH physical exam (which they have little time for), they will rely on a static picture (again which shows normal aging) and then blame anything the person feels on some “change” in the picture. That and a vast majority of patients just expect the image because they do not really know the whole truth. They do not understand that x-rays really are only good for seeking out the bad stuff (i.e. fracture, dislocations, or other bony abnormality). They do not serve to answer the question most people are really asking…why does my neck or arm hurt?

Does that mean one should be asking for an MRI?

Absolutely not. Unless one is looking to have surgery.

In the majority of cases of neck pain, conservative care will help guide a person out of pain and back into normal function. Should that path fail…and only if there starts to become a higher level of concern, then and only then should x-rays or other advanced testing be considered.

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