The use of plain film radiography in the early stages of acute low back pain has been challenged. Health care providers who maintain their own radiological services tend to charge more and take more X-rays than those who refer patients out for such services. Chiropractic physicians generally own their own X-ray equipment and see a predominance of low back pain in practice. There is a basis for unjustified utilization of X-ray. The chiropractic physician justifies the use of X-ray in the management of low back pain to a) rule out pathology, b) perform a biomechanical evaluation, c) protect against medicolegal action, d) obtain financial gain and e) out of habit. The literature fails to support or justify the use of X-ray in the management of acute low back pain for any of the above listed reasons. Arguments to this effect are presented. A guidelines is provided as a suggestion for improved decision making regarding the use of X-ray in the low back patient. A challenge is issued to the practitioners who treat low back pain to seek better justification for their current practice patterns.
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