Lower back pain (LBP) is one of the most common musculoskeletal complaints, often prompting patients to seek imaging for answers. However, current evidence-based guidelines emphasize that routine imaging is rarely necessary for most cases of LBP. At Creekside Performance Center, we take a functional approach to chiropractic care—focusing on movement and rehabilitation rather than relying solely on structural findings from imaging.
When Is Imaging Necessary?
While imaging can be valuable in specific situations, research suggests that most cases of LBP improve with conservative care without the need for X-rays or MRIs. According to the American College of Physicians (ACP) and the Choosing Wisely campaign, imaging should be reserved for patients with:
Red Flags – Severe trauma, unexplained weight loss, history of cancer, fever, or signs of infection.
Neurological Deficits – Progressive weakness, loss of bowel or bladder control (e.g., cauda equina syndrome), or significant sensory changes.
Persistent Pain – Symptoms lasting longer than six weeks despite conservative care.
Structural Findings vs. Functional Assessment
One of the biggest misconceptions in healthcare is the assumption that structural changes seen on imaging always correlate with pain. In reality, studies have shown that degenerative changes such as arthritis, disc bulges, and spinal stenosis are common in asymptomatic individuals. Research published in The New England Journal of Medicine and Spine has demonstrated:
Disc Degeneration is present in 40% of pain-free individuals in their 30s and over 80% of those over 50.
Disc Bulges & Herniations occur in over 50% of people without pain.
Osteoarthritis & Spinal Stenosis are often incidental findings that do not necessarily indicate the cause of symptoms.
The Chiropractic Approach: Trial of Care Before Imaging
Rather than relying on imaging as a first step, an evidence-based chiropractic approach prioritizes a trial of care to improve function and reduce pain. This includes:
1. Patient History & Functional Examination
A thorough assessment of movement patterns, posture, and muscle imbalances provides better insight into the root cause of pain than imaging alone.
2. Conservative Treatment Strategies
Chiropractic Adjustments – Improve joint mobility and reduce mechanical stress.
Manual Therapy – Soft tissue techniques relieve tension and improve circulation.
Corrective Exercise & Rehabilitation – Strengthening weak muscles and improving movement patterns can address dysfunction.
Dry Needling – Reduces muscle tightness and enhances healing.
3. Reassessment & Outcome-Based Care
Patients are monitored for functional improvements rather than imaging findings. If significant progress is not achieved within a reasonable timeframe, imaging may then be considered to rule out less common structural issues.
Takeaway: Function Over Findings
At Creekside Performance Center, we emphasize treating the patient—not the MRI. Evidence clearly supports a functional, movement-based approach to LBP rather than unnecessary imaging that may not change treatment plans. If you're experiencing lower back pain, let us help you recover through an individualized, research-driven approach.
Book an appointment today and take the first step toward lasting relief!