If your lower back hurts, should you get an X-ray first?

If your lower back hurts, you might think that getting an X-ray first will make you feel relieved.

An X-ray is useful for confirming the arrangement of spinal bones, fractures, and some degenerative changes. However, it does not show the disc and nerves/muscles in detail.

For common lower back pain without major trauma or warning signs, a history and physical and neurological examination can be performed first. An X-ray may be considered selectively if its result would change the treatment plan.

• Arrangement and curvature of the vertebral bones
• Compression fracture and some fractures
• The vertebrae are in a slipped position front to back.
• Changes in the spacing between vertebrae
• Bone spurs and degenerative changes in the joints
• Partial spinal deformity and scoliosis
• Status of metal fixation after surgery

The fact that changes are visible on the imaging does not mean that they are the current cause of pain. Symptoms and the results of the physical examination must be reviewed together.

The intervertebral disc and nerve, which are the core structures of a lumbar disc herniation, are not directly visible in detail on a standard X-ray.

If the space between vertebrae is narrowed, degenerative changes in the intervertebral disc can be indirectly inferred. However, MRI may be more suitable for checking disc protrusion or extrusion and nerve compression.

Therefore, a normal X-ray does not completely rule out problems with discs, muscles, or joints.

When there has been a major trauma

This is the case when severe pain occurs after a traffic accident, a fall from a height, or a strong impact.

When the risk of fracture is high

• Osteoporosis
• New lower back pain in the elderly
• Long-term use of steroid medication
• Previous compression fracture
• Severe pain following a mild impact

When the bone structure needs to be confirmed

It can be used to take images when it is necessary to check for spinal deformity, slipping of the vertebrae, or post-surgical status.

When inflammatory diseases or other bone diseases are suspected

Depending on the symptoms and medical history, an X-ray of the lower back and pelvis may be considered.

In the following situations, you may proceed with history taking and physical examination first.

• No major trauma
• Fracture risk is not high
• Leg muscle strength is not diminished.
• No changes in urination, defecation, or perineal sensation.
• No high fever and no risk of cancer or infection.
• X-ray results are not expected to change the initial treatment approach

Not performing an imaging examination immediately does not mean that the consultation is being neglected. This is the process of distinguishing the necessary patients and selecting appropriate examinations.

As you age, the space between vertebrae may narrow, and bone spurs or joint changes may occur.

Such changes can also be found in people without pain. The presence of 'degenerative changes' in the reading results does not mean that the spine is dangerously damaged or that it is necessarily the cause of pain.

It is necessary to simultaneously assess where the current pain occurs during specific movements, whether muscle strength and sensation are stable, and what level of daily functioning is present.

The following information may not be fully visible on the X-ray.

• Tension in muscles and ligaments
• Limited joint movement
• Changes in the disc and nerve
• The actual movement during which pain occurs
• Function of the pelvis and hip joint
• Strength of the torso and buttock muscles

Therefore, a normal X-ray does not mean there is no pain. The reason why history taking and physical examination are important.

X-ray

It allows for relatively simple confirmation of bone alignment, some fractures, and degenerative changes.

CT

It shows the detailed structure of bones and complex fractures more clearly than X-rays. Radiation is used.

MRI

We carefully examine the disc, nerves, spinal canal, and soft tissues. We do not use ionizing radiation, but this examination is not required for all lower back pain.

The examination should not be chosen based on higher cost or greater precision, but rather by selecting the method appropriate for the current issue you wish to address.

An X-ray is an examination that uses radiation.

The medical team determines whether to perform the imaging by considering both the information obtainable from the examination and radiation exposure.

If you are pregnant or think there is a possibility of pregnancy, you must inform us before the imaging. If you have previously undergone imaging, we can also review whether a new scan is absolutely necessary.

• If a fracture is confirmed or suspected, fracture management takes priority over Chuna manual therapy.
• We do not determine the necessity of Chuna manual therapy based solely on degenerative changes in the bones.
• Check the status of spinal surgery and fixation devices to adjust treatment methods and intensity.
• If there are neurological symptoms that cannot be explained by X-ray, consider MRI or consultation.
• We evaluate current movement and pain along with nerve function rather than relying solely on imaging.