Do You Need an MRI Before Seeing a Chiropractor?

Do you need an MRI before seeing a chiropractor? Usually not. For most back and neck pain, guidelines advise against imaging first, and scan findings can send you down the wrong road.

Do you need an MRI before seeing a chiropractor?

No. The exam comes first. The American College of Physicians’ imaging advice puts it this way: diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious underlying condition. In other patients, evidence indicates routine imaging isn’t associated with clinically meaningful benefits but can lead to harms. The authors added a line worth remembering: “more testing does not equate to better care.”

So you don’t need to book a scan before your first appointment. If you already have one, bring the report and the images.

Why scan findings can mislead you

A systematic review of 33 studies covering 3,110 people with no back pain found degenerative changes on CT or MRI in large shares of them, rising with age. Disc degeneration appeared in 37% of 20-year-olds and 96% of 80-year-olds. Disc bulges: 30% at age 20, 84% at age 80. Disc protrusions: 29% to 43%. Annular fissures: 19% to 29%. The authors concluded that many of these findings are likely part of normal aging and unassociated with pain, and have to be read in the context of the patient’s condition.

That’s why “bulging disc” on a report doesn’t automatically explain your pain, and why a normal-looking scan doesn’t mean nothing’s wrong. Our guides to a herniated disc and degenerative disc disease go deeper.

What about X-rays?

Dr. Patel’s office has in-house digital X-rays, and the first visit includes them if they’re clinically needed. Not everyone gets them. Read more on our spinal X-ray page.

The first visit also includes a consultation, an orthopedic and neurological exam, and a report of findings before the first adjustment.

When imaging does make sense

When there are signs of a serious underlying condition or neurologic deficits that are severe or getting worse, imaging and medical workup come first. That’s the exception the guideline carves out. Fast-worsening weakness, new bladder or bowel changes, or numbness in the groin need urgent care. Our page on acute back pain that can’t wait covers where to go.

Frequently Asked Questions

References

1. Chou R, Qaseem A, Owens DK, Shekelle P. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011;154(3):181-189. PubMed: 21282698
2. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. PubMed: 25430861