Shouldn't X-rays be taken for people with severe low back pain? I can hardly move around, yet my doctor says stay active. I was told X-rays were not needed at this time. What gives?
New guidelines on the diagnosis and treatment of low back pain (LBP) have recently been published. The American College of Physicians (ACP) and the American Pain Society (APS) worked together to develop these guidelines.

They reviewed recent results of studies for evidence of the benefit of various options in the treatment of LBP. The amount of benefit was described from small to substantial. The quality of evidence ranged from poor to good.

All evidence points to the need for patients to have proper guidance and education about back pain. The number one piece of advice should be to stay active. Taking a day or two to recover from a back injury or back pain is acceptable. But after that, activity and movement are essential.

Routine X-rays of all LBP patients are no longer the standard of care. Studies have shown over and over that such tests are not needed. They are expensive and drive up the cost of health care unnecessarily.

X-rays or other imaging studies are only recommended in certain situations. Diagnostic imaging may be advised for patients with signs of severe neurologic involvement. The same is true for patients with rapidly worsening neurologic symptoms.

If the physician suspects serious pathology such as a fracture or tumor, then X-rays will likely be ordered. But the history and results of the physical exam are usually enough to guide the doctor. These tools are useful in deciding the need for further testing and determining the best plan of care.