Do I Need an MRI or an X-Ray for My Pain?
Adapted from Dr. Saballa's voice memos and review notes, August 2026.
Summary
- Most people who ask for an MRI or X-ray do not need one first.
- The starting point is an in-person assessment: your history and goal, a hands-on evaluation, and how you move.
- Whether imaging is the right call comes out of that evaluation, not ahead of it.
- If your pain is getting worse fast, or it scares you, get seen today.
In this post
Do I need an MRI or an X-ray for my pain?
Most people who ask me for one do not need it.
In my office, "a test or assessment that most people don't need but they ask for are X-rays and MRIs". Most is not all. Some people do need imaging, and that call belongs to a clinician who has actually put hands on you. But it is not the first move, and it is not the thing that tells us how to start.
The first move is an assessment. A real one, done in person, in an order, ending with your goal. That is the part people skip because it does not come with a picture.
Why do people want the scan so badly?
Because pain is confusing, and a photograph feels like the end of the confusion.
"most people are really looking for an answer, so they assume that seeing a picture of it will give them that answer."
I understand the instinct completely. You hurt, nobody has told you why, and an image feels like proof. It feels like the moment someone finally takes you seriously.
But the picture is one input. It is not the whole answer, and it is not where I start.
What does a sports chiropractor check first?
Three things, in this order.
First, your story. "when someone new walks in, the first thing I assess is their history through a verbal assessment." What happened. When it started. What makes it worse, what makes it better, what you have already tried.
I close that conversation the same way every time. "the last question I always ask in this first verbal assessment is, what is your goal?" Not what hurts. What you are trying to get back to. Playing a full season, picking up your kid, running the race you already registered for. That answer changes what we do next.
Second, hands on. "The second thing I assess will be a hands-on evaluation, which includes orthopedic and neurological assessments" That is me testing, not guessing.
Third, how you move. The hands-on work and the movement check sit in a fixed order for me: "The second is a palpation and orthopedic assessment, and the third is a movement quality assessment". A person standing still and a person moving are not giving you the same information.
Why not just get the scan first?
Because I do not want to build a plan around an image.
"we never want to begin care and treat a picture."
An image shows structure. It does not show what you can do, what you avoid doing, what your goal is, or how you move under load. Those are the things I need in order to give you something to work on, and none of them come back in a report.
So the picture is not the villain here. Starting with it is. Assessment first, then we know whether an image would even change anything.
When is imaging the right call?
Sometimes it is, and I want to be honest that this is not a question you should settle from a blog post.
Whether you need imaging is a decision a clinician makes after examining you. Your history, your exam, your timeline, and what has already been tried all feed into it, and a person who has done that exam can tell you things a search result cannot. If you have been told to get imaging, get it. If you have not, ask the person who examined you why.
Here is how I decide, in my own words:
"I will send a patient out for imaging if they are not responding to care as expected or if something in the evaluation indicates a significant structural pathology."
There are also red flag situations where the answer is not "wait and see" and not "book with me." Those are see a doctor now, today. I am not going to list them here as if a checklist could replace an exam.
If something about your pain scares you, or it is getting worse fast, do not wait on me. Get seen today.
What would you rather I spend the money on?
Care.
"what I would rather they spend that money on were or are treatments from a non-biased perspective."
Non-biased is the part that matters: care chosen for the goal you named in that first conversation.
For a lot of people that money goes further as "more forms of conservative care, like treatments and supportive adjuncts, maybe compression sleeves, maybe other tools or, um, supportive modalities around it". Note the maybes. Those are options that sometimes fit, not a shopping list, and which ones apply to you comes out of the assessment, not out of an article.
The point of writing this is education: the more you understand about how this decision gets made, the better your own decisions get. Money spent on care, and on doing the work, is money spent on the goal.
One last thing
This is education, not medical advice, and reading it does not make me your doctor. Your situation is yours. If something is getting worse, or it scares you, go get seen by someone who can examine you in person.
And when an exam does point toward imaging, this is what I actually say to the patient:
"Based on the findings of our evaluation today, I believe that obtaining advanced imaging, such as X-ray or MRI, will give us the right information to make the best decision on how to best move forward with your case."
Common questions
Do I need an MRI before starting care?
Usually not. Whether you need imaging is a clinical decision made after an in-person exam, not before it.
What gets checked before any imaging?
Three things, in order: your history and your goal, a hands-on orthopedic and neurological evaluation, and how you move.
When does imaging make sense?
When something in the evaluation indicates a significant structural pathology, or when someone is not responding to care as expected. Red flag situations mean see a doctor today, not wait and see.
What should the money go toward instead?
Care chosen for the goal you named, from a non-biased perspective. Which options apply to you comes out of the assessment.
Book a consult and we start with the exam, not the picture.