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Do you need a spine x-ray before starting chiropractic treatment?

In Singapore, most chiropractors require you to have an x-ray before you can start treatment.

It’s such a common occurrence that you can probably pick up multiple instances of such complaints on Google if you do a little quick search:

chiropractic first, spine x-ray
Source <a href=httpswwwredditcomrsingaporecomments359v8li do not understand this situation chiropractic target= blank rel=noopener noreferrer>Reddit<a>


full potential chiropractic, chiropractic treatment
Source <a href=httpsforumsingaporeexpatscomviewtopicphpt=92637 target= blank rel=noopener noreferrer>Singapore Expats Forum<a>

It is so prevalent that when UFIT Clinic published a chiropractor vs physiotherapist vs osteopath comparison, they made it a point to specifically highlight that chiropractors heavily rely on x-rays:

ufit clinic
Source UFIT Clinic

Should I get an x-ray before seeing a chiropractor?

Here’s what the latest research — literally published a couple of days ago — says about chiropractic x-rays:

“We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.”

Source: The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature

x-ray singapore, spine x ray
The all time famous <a href=httppatientmediacomspinal decay placement chart target= blank rel=noopener noreferrer>spinal decay chart<a> that you see in most chiropractic clinics in Singapore You can buy a plain copy for $40 or a laminated one at $45 via Patient Media

Chiropractors really love to use x-rays for show and tell.

I can tell you this because I worked for a shopping mall chain chiropractic for a grand total of two weeks. I was provided with a sales manual that is over 100 pages long.

It dictates exactly what you are meant to say to the patients and the conversation is designed to facilitate sales. They even have multiple slide decks to go with the script.

The part that they love to talk about is alignment or degeneration.

“Aiyo, you see your spine here out of place already leh. If you don’t have treatment, next time cannot walk.”

“You see the bone here is slightly rotated/tilted compared to the rest. If you don’t fix, your pain will only get worse.”

P.S. The clinic was keen to run assessments and examinations on my sales skills before they start trusting me to close deals see patients. It’s ridiculous because in my two weeks, they showed zero interest in my clinical knowledge or competency.

chiropractic singapore, cost of x-ray
Physiotherapists around the world are calling out on chiropractors for poor clinical practice Source <a href=httpstwittercomDrSethPTstatus1282728619521929217>Twitter<a>

Just to be clear, I am not the only person calling out chiropractors who abuse plain film x-rays here.

Paul Stoenescu the osteopath from UFIT Clinic blogged about it.

Seth Peterson, a physiotherapist / physical therapist, twitted about it.

Even Singapore chiropractor Kelvin Ng also wrote against such practices in his blog.

spinal radiographs, chiropractor singapore

From this study, it is really clear that there is no value to x-rays in the absence of red flags.

That’s not to say x-rays have NO value at all. If you are suspected of having a spinal fracture — or any fracture at all — please do get an x-ray to rule it out.

X-ray does have its role to play in clinical practice.

If you are referred for x-rays, be sure to ask what are they trying to look for.

Just to be safe is NOT good enough a reason. We know that imaging have long-term undesirable consequences.

In one of my earlier posts on disc herniation, back pain patients who under go imaging spend more money on treatments, experience more pain, take longer to recovery, and report poorer quality of life. It’s a lose-lose-lose-lose situation.

How do chiropractors know where to adjust?

upper cervical chiropractor, neck x-ray
No one is contesting that structural chiropractors can draw very fancy x ray lines and take very specific measurements However research doesnt show that these practices have any meaningful impact on patients outcomes Source <a href=httpswwwpinterestcompin456200637233439855 target= blank rel=noopener noreferrer>Pinterest<a>

A lot of chiropractors, especially those focused on structural techniques such as Chiropractic BioPhysics (CBP), will tell you that they need x-rays to know where to adjust.

And that without x-rays they are just “going in blind”.

Those are fair narratives in the sense that it does sense but they are also FALSE beliefs.

The same study pointed out that no research was able to provide evidence that the x-rays measurements or methodology used by CBP chiropractors had any diagnostic value.

There was no data to show sensitivity, specificity, or predictive values. This is scientific talk for chiropractic x-ray measurements tell us nothing.

According to the researchers, “we do not know if these measurements are evaluating clinically important outcomes for conditions of the cervical or lumbar spine.”

In short, unless there is a suspected fracture or pathology that needs to be ruled out, you shouldn’t be getting an x-ray.

What does a chiro do?

Chiropractors are trained musculoskeletal health experts that can diagnose and treat your spinal pain.

X-rays, when used according to clinical guidelines, do have a value in chiropractic practice.

If you found yourself questioning your x-ray or MRI referral, book in an appointment with me via the form below to discover the difference evidence-based care can make.


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.