X-ray Imaging - Useful in specific situations — limited in many others
Get WISE - Get WELL - Get ON
X-rays can be very useful when there is a specific clinical question, such as suspected fracture, significant structural change, or concern about serious underlying disease. Outside of these situations, they often add little to the understanding of pain, particularly in areas like the spine where muscles, discs, and nerves cannot be seen.
When it helps, when it doesn’t — and why assessment comes first
Condition Related Articles
CT Scans
MRI Scans
Ultrasound Scans
For this reason, X-ray imaging should follow careful clinical assessment rather than being used as a routine or default investigation. This helps ensure imaging is used when it is most likely to provide meaningful information.
This is also why you may be advised against having an X-ray by your GP or First Contact Practitioner, especially for spinal pain. In many cases they know that an X-ray is unlikely to show the cause of symptoms, may highlight age-related changes that are not actually relevant, and is unlikely to alter the course of treatment. Where there are no signs of fracture, serious disease, or significant structural abnormality, assessment and appropriate management are usually more informative and more effective than imaging alone.
Related Blog Posts
SPECT CT
- Why does my GP keep reusing to Xray my back? I have had low back pain for ages.
- I hurt my knee playing football 5 weeks ago but the nurse won't send me for an xray.
- Is it safe having an xray?
How many X-rays can I have?
What an X-ray actually shows
X-rays use a small dose of ionising radiation to create images based on tissue density. Dense structures such as bone absorb more radiation and therefore appear clearly. This makes X-ray imaging well suited to identifying fractures, dislocations, alignment issues, and more advanced joint changes.
In specific clinical situations, X-rays can also be helpful when there is concern about serious underlying pathology affecting bone, such as infection, inflammatory disease, or cancer. In these cases, imaging plays a role in confirming or excluding diagnoses that require further investigation or referral.
What X-rays do not show well
X-rays do not provide meaningful detail of soft tissues. Muscles, tendons, ligaments, discs, nerves, and most cartilage cannot be properly visualised. As a result, many common musculoskeletal problems simply do not show up on X-ray.
This is particularly important when interpreting spinal imaging. Findings such as disc space narrowing, osteophytes, or so-called “degenerative changes” are extremely common with age and are frequently present in people who have no pain at all. On their own, these findings rarely explain symptoms or guide treatment decisions.
X-rays and spinal pain: why they are used selectively
For most people with back or neck pain, spinal X-rays do not change management or improve outcomes. This is why clinical guidelines advise against routine spinal X-ray imaging in the absence of specific warning signs.
In spinal cases, X-rays are primarily used to rule out serious pathology. This includes suspected fracture (particularly following trauma or in people with osteoporosis), suspected cancer, infection, inflammatory disease, or significant structural deformity. Outside of these situations, careful assessment and appropriate management are usually more informative than imaging.
X-rays and spinal pain: why they are used selectively
When an X-ray may be the right choice
There are situations where an X-ray is clearly the most appropriate investigation. Acute injuries with suspected fracture, significant joint trauma, or visible deformity are good examples. In these cases, X-ray imaging provides fast, reliable information that directly influences clinical decisions.
The key consideration is not the presence of pain itself, but whether imaging is likely to answer a meaningful clinical question or change the course of treatment.
What is it like having an X-ray?
aving an X-ray is usually quick and straightforward. You will be asked to position the part of your body being examined so that clear images can be taken. This may involve standing, sitting, or lying down, depending on the area being imaged. The radiographer will guide you carefully and ensure you are positioned as accurately as possible.
During the X-ray itself, you will be asked to keep very still for a short moment while the image is taken. The process is painless, and you will not feel the radiation. In some cases, the radiographer may step briefly behind a screen or leave the room while the image is captured, which is a normal safety measure.
Most X-ray appointments take only a few minutes from start to finish. There is no recovery time required, and you can return to your normal activities immediately afterwards. Results are usually reviewed by a radiologist and then shared with the clinician who requested the scan, who will interpret the findings in the context of your symptoms and examination.
As with all imaging, the X-ray itself is only one piece of information. The images are most useful when considered alongside a proper clinical assessment, rather than in isolation.
Radiation and safety
X-rays use a small amount of ionising radiation to create an image. The dose involved in most diagnostic X-rays is low and carefully controlled, and the benefits of imaging generally outweigh the risks when there is a clear clinical reason for the scan.
That said, because X-rays involve radiation, they are not used indiscriminately. This is another reason why clinicians are selective about when they are requested, particularly for areas like the spine where imaging often does not change management. Avoiding unnecessary X-rays helps minimise exposure while ensuring imaging is used where it genuinely adds value.
If an X-ray is recommended, it means the clinician believes the information gained is important for decision-making. If it is not recommended, this is usually because it is unlikely to alter treatment rather than because of safety concerns alone.
Imaging as part of decision-making, not a substitute for it
X-rays are a valuable tool when used for the right reasons and at the right time. They are not designed to explain most musculoskeletal pain and should not replace clinical assessment.
Good care comes from understanding the person in front of you — their history, symptoms, examination findings, and goals — and then deciding whether imaging will genuinely add value. When imaging is needed, it should clarify decisions, not complicate them.
X-ray FAQs
1. Do I need an X-ray for my pain?
Not necessarily. Many musculoskeletal problems, particularly back and neck pain, do not benefit from X-ray imaging. X-rays are most useful when there is a specific concern such as fracture, significant structural abnormality, or serious underlying disease. If imaging is unlikely to change treatment, it is often not recommended.
2. Why did my GP or First Contact Practitioner say no to an X-ray?
This is usually because they know an X-ray is unlikely to show the cause of your symptoms or alter how your condition is managed. In areas like the spine, X-rays do not show muscles, discs, or nerves and commonly report age-related changes that are often unrelated to pain.
3. Can an X-ray show muscle, disc, or nerve problems?
No. X-rays are designed to show dense structures such as bone. They do not show muscles, tendons, ligaments, discs, or nerves in any meaningful detail. Problems affecting these tissues are usually assessed clinically or with other imaging if appropriate.
4. Why are spinal X-rays often discouraged?
For most people with back or neck pain, spinal X-rays do not improve outcomes or change management. Common findings such as degeneration or “wear and tear” are extremely common in people without pain and rarely explain symptoms on their own.
5. What does “wear and tear” on an X-ray actually mean?
It usually refers to normal age-related changes in joints or the spine. These changes are very common and increase with age. They do not automatically mean damage, and they are often present in people who have no pain or functional problems.
6. When is an X-ray clearly appropriate?
X-rays are most appropriate when there is suspected fracture, significant joint trauma, visible deformity, or concern about serious underlying conditions such as infection, inflammatory disease, or cancer affecting bone. In these situations, X-rays can directly influence management.
7. Are X-rays safe?
X-rays use a small amount of ionising radiation. The dose from most diagnostic X-rays is low, and when there is a clear clinical reason, the benefits outweigh the risks. Because radiation exposure is cumulative, clinicians aim to avoid unnecessary imaging.
How does the shoulder achieve such a wide range of movement?
The shoulder’s mobility comes from the coordinated motion of several joints — the glenohumeral, AC, sternoclavicular, and scapulothoracic joints. Muscles around the shoulder blade and chest wall also contribute to smooth, efficient movement.
8. Will having an X-ray change my treatment?
Sometimes, particularly if a fracture or serious condition is identified. In many cases of everyday musculoskeletal pain, X-ray findings do not change treatment, which is usually guided more by symptoms, examination findings, and response to rehabilitation.
9. What is it like having an X-ray?
X-rays are quick and painless. You will be positioned by a radiographer and asked to keep still briefly while the image is taken. The process usually takes only a few minutes, and you can return to normal activities straight afterwards.
10. How should X-ray results be interpreted?
X-ray findings should always be interpreted in the context of your symptoms and clinical assessment. An X-ray on its own is not a diagnosis. Good care comes from combining imaging, examination, and clinical judgement rather than relying on scans alone.
Why You Should Choose Chris Heywood Physio
The most important thing when seeking help is finding a practitioner you trust—someone who is honest, responsible, and clear about your diagnosis, the treatment you really need, and whether any follow-up appointments are necessary.
I’m not here to poach you from another therapist, but if you’re looking for a new physiotherapist in Northamptonshire or simply want a second opinion, here’s why many people choose to work with me (read my reviews):
Over 25 Years of Experience & Proven Expertise
With 25+ years of hands-on physiotherapy experience, I’ve built a trusted reputation for clinical excellence and evidence-based care. My approach combines proven techniques with the latest research, so you can feel confident you’re in safe, skilled hands.
Longer Appointments for Better Results
No two people—or injuries—are the same. That’s why I offer 60-minute one-to-one sessions, giving us time to:
-
Thoroughly assess your condition
-
Provide focused, effective treatment
-
Explain what’s really going on in a clear, simple way
Your treatment plan is tailored specifically to you, aiming for long-term results, not just temporary relief.
Honest Advice & Support You Can Trust
I’ll always tell you what’s best for you—even if that means you need fewer sessions, not more. My goal is your recovery and wellbeing, not keeping you coming back unnecessarily. I have low overheads nowadays and I do not have pre-set management targets to maximise patient 'average session per condition' (yes it does happen commonly and I hate it with a passion - read my article here)
Helping You Take Control of Your Recovery
I believe the best outcomes happen when you understand your body. I’ll explain your condition clearly, give you practical tools for self-management, and step in with expert hands-on treatment when it’s genuinely needed.
Looking for a physiotherapist who values honesty, expertise, and your long-term health?
Book an appointment today and take the first step towards feeling better.
Contact Info
On a Monday and Tuesday I work as a advance musculoskeletal specialist in primary care but I can still be contacted for enquiries. You are welcome to call but it is often faster for me to reply via an email or watsapp message, simply as my phone will be on silent in clinic. Either way, I will reply as soon as possible, which in the week, is almost always on the same day at the latest.
Clinic Opening Hours
The Clinic is located at 2 Old Road, Scaldwell, Northants, NN6 9LA
Tel: 07576 473422 (Feel free to watapp)
** Please note that online sessions and Aquatic sessions be arranged outside of normal clinical hours on request.**
Sat -Sun
Closed (Family Time!)
0900 - 1330
Closed for Contract Work
Weds - Fri
Mon - Tues