Why Routine X-Rays for “Postural Misalignments” Should be Questioned
The Issue at a Glance
In their recent review, Williams and colleagues question the common chiropractic practice of using routine, repetitive spinal X-rays to locate “postural misalignments” such as reversed cervical curvature. Their key message: while X‐rays show anatomy, they rarely tell us how someone moves, whether the tissues are structurally damaged, or whether the radiographic findings are the source of pain.
What the Evidence Says
Many individuals without pain exhibit the same “abnormalities” (e.g., altered spinal curves) that chiropractors often link to symptoms.
Radiographic measurements vary widely due to factors like patient positioning, morphological differences, and even emotional state—putting into question their precision and reliability.
Over the last 20 years, medical boards and associations around the world have aimed to reduce unnecessary imaging and emphasise clinical assessment and red-flag screening rather than routine imaging.
What This Means for Your Practice
As a sports chiropractor focused on strength-based rehab at Strength & Rehab Co., I believe this review reinforces several key philosophies I use with my clients:
Movement & load tolerance trump static alignment
X-rays show structure, but they don’t show how you lift, push, squat or tolerate training loads. My focus is assessing movement patterns, strength capacity and functional resilience—not simply “fixing” an X-ray image.Imaging only when it adds value
I don’t recommend routine spinal X‐rays unless there are red flags (fracture risk, signs of systemic disease, unexplained neurological signs). For most active individuals, the rehab plan is built from assessment + movement + strength data—not imaging alone.Communication matters
The review highlighted how imaging can mislead patients into believing their posture or curve is the root cause of pain. I take time to explain what the testing shows (or doesn’t), what we can do about it, and how strength and movement are our actionable tools.
Practical Takeaways for You
If someone suggests you must get an X-ray simply because their posture appears “wrong,” ask: “How will that change our plan of movement, strength or load?”
Prefer practitioners who integrate movement assessment, strength testing and meaningful exercise progressions over those who rely primarily on aligning structures via imaging.
Not all “abnormal” curves on X-ray cause pain—many people train and perform at a high level despite them. Your rehab success will hinge more on capacity, control and strength than the angle on an X‐ray.
Why Strength-Based Rehab Makes the Difference
At Strength & Rehab Co., we prioritise active rehabilitation, focusing on how you move today and how you will perform tomorrow. We engage you in the process of restoring function, increasing load tolerance and building long‐term resilience. While hands-on care and manual therapy have their place, they are adjuncts—not the foundation.
If you’re dealing with pain, recurrent training setbacks or just want to optimise your movement and strength, let’s skip the “fixing posture via scanner” route and shift into the “build your capacity and move stronger” mode instead.
Reference:
Williams B., Gichard L., Johnson D., Louis M. (2024) An investigation into the chiropractic practice and communication of routine, repetitive radiographic imaging for the location of postural misalignments. J Clin Imaging Sci. DOI:10.25259/JCIS_68_2024.