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Should I ask my doctor for X-rays of my spine? I've had back pain now for six months and it's not getting any better.

Some spine clinics advocate taking spinal X-rays with each new patient who has low back pain (LBP). Other experts suggest X-rays are best saved for those patients (like yourself) who don't get better with conservative care.

X-rays can be useful when looking at the location, type, and amount of spinal degeneration. They also provide information about alignment, fractures, or other deformities.

But the cost of and exposure to unnecessary X-rays prompts some doctors to avoid ordering them routinely. This diagnostic step is only taken when there are justifiable reasons to do so.

There are no standards or studies to guide physicians in making this decision. One study recently published did show that additional dynamic flexion-extension radiographs are not needed unless surgery is planned.

Back pain that has been present three months or more is often considered mechanical. This means there is an imbalance in the soft tissue and/or bony structures contributing to the problem. Conservative care with mobilization or manipulation, exercise, and postural and behavioral training are still the suggested management plan.

Talk to your doctor about your concerns and questions. You may benefit from further testing and/or a change in the treatment program.

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