When are x-rays needed?
When are x-rays needed?
For patients with musculoskeletal complaints x-rays are usually not need unless there are red flags present. This means that the vast majority of patients do not need x-rays.
What are red flag?
Red flags are when the patient’s history or examination point to possible serious conditions. Examples of red flags include:
- A history of trauma
- Neurologic findings on the examination
- Current unexplained Fever
- Serious medical conditions such as cancer
- A history of recent onset bowel or bladder dysfunction
- Suspected infection
When there are no red flags present x-rays are not needed to commence a trial of care. In fact x-rays can be detrimental.
How can x-rays be detrimental?
Anyone who is over the age of 20 will have some type of degeneration that can be seen on x-rays. Degeneration however is essentially a gray hair of the spine. Degenerative findings are natural parts of aging and are not a reason to worry. The vast majority of time not they are not the source of pain. When people see these changes on imaging it has been shown that it worsens their outcomes. Believing that there is something wrong with your spine has quantifiable detrimental effects.
Are there other times when x-rays or MRIs should be ordered?
If a patient does not respond to a trial of conservative care then it is appropriate to take imaging. In many cases this means at least one month of treatment with either no positive changes or potentially even some negative changes. In those cases imaging, such may be of use.
About the Author
Medically reviewed by Dr. Alex Tauberg, DC, RN, CCSP®, PSP | Last reviewed: March 6, 2026
Reviewed for clinical accuracy using an evidence-based, conservative care framework.
Dr. Alex Tauberg, DC, RN, CCSP®, PSP
Primary Spine Practitioner & Certified Chiropractic Sports Practitioner
Founder of The Pittsburgh Chiropractor LLC, Dr. Tauberg is a dual-credentialed healthcare provider (Doctor of Chiropractic and Registered Nurse). He specializes in evidence-based spine care and sports medicine, leveraging his advanced training in spine care, rehabilitation, and sports medicine to help active individuals and athletes recover from musculoskeletal injuries and return to the activities they enjoy.
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Education & training
- Doctor of Chiropractic: National University of Health Sciences
- Primary Spine Practitioner Certification: University of Pittsburgh
- Nursing Education: Community College of Allegheny County (CCAC); Capella University
- Graduate Nursing: William Paterson University (FNP program)
- Undergraduate: Eckerd College (Psychology)
Certifications Primary Spine Practitioner (PSP)
Certified Chiropractic Sports Practitioner (CCSP®)
Certified Strength & Conditioning Specialist (CSCS)
Emergency Medical Responder (EMR)
Professional Affiliation Pennsylvania Chiropractic Association
Direct Clinical Line (412) 517-8124
Content Standards Evidence-based guidance, reviewed and updated regularly
Pittsburgh: 55 Alpha Drive West Suite 6, Pittsburgh, PA 15238 | Gibsonia: 5332 William Flynn Hwy, Gibsonia, PA 15044 Clinical Content Last Verified: March 6, 2026
Educational disclaimer: This content is for general informational purposes and does not replace individualized medical advice, diagnosis, or treatment.
If you have severe symptoms, progressive weakness, fever, unexplained weight loss, recent trauma, or loss of bowel or bladder control, seek urgent evaluation.