Do You Need X-Rays Before Chiropractic Care in Markham?

Published by Markham Pain Clinic · November 12, 2026

X-rays are not automatically required before chiropractic care. In Ontario, a chiropractor should first use your health history and examination to decide whether an X-ray could clarify a specific finding or change the plan.[1] In Markham, the decision should also weigh benefits, limits, radiation exposure, pregnancy, and previous imaging.[1]

Do you need an X-ray before chiropractic care?

Not everyone does. The College of Chiropractors of Ontario says a chiropractor should order radiographs only when the history, examination, or other diagnostic tests indicate that imaging could better identify, confirm, or rule out a finding.[1]

An X-ray is one source of information.[1] It does not replace a conversation about your symptoms, health history, recent injuries, daily activities, or goals.[1] The clinician should consider whether the result is needed for a diagnosis, clinical impression, or plan of care.[1]

What happens before an X-ray is considered?

A chiropractic assessment may include questions about when the concern began, whether there was a fall or other injury, what movements are difficult, and whether you have weakness, numbness, fever, unexplained weight loss, a history of cancer, or a recent infection.[1][3] The physical examination depends on the concern and your consent.[1][2]

Before ordering an X-ray, an Ontario chiropractor should also try to avoid unnecessary duplicate imaging, consider pregnancy and other contraindications, and explain why the image is being considered.[1] If you already have a recent report or image, mention it during the appointment.[1]

When might imaging be considered for back or joint concerns?

Imaging may be considered when the history or examination raises concern for a fracture, nerve injury, infection, cancer, or another condition that needs investigation. Choosing Wisely Canada lists possible warning findings for low-back pain such as a history of cancer, unexplained weight loss, recent infection, loss of bowel or bladder control, abnormal reflexes, or loss of muscle power or feeling in the legs.[3]

These findings do not tell you what the diagnosis is.[3] They are reasons for prompt professional assessment.[3] Seek urgent medical care for new loss of bowel or bladder control, rapidly worsening weakness, major trauma, or other severe or sudden symptoms.[3] Call 911 for an emergency.

Why are routine X-rays not always helpful?

An image can reveal changes that are unrelated to the symptoms that brought you in.[3] That can cause worry or lead to more tests that may not help.[3] X-rays also use ionizing radiation, so the decision should balance expected benefit against risk.[1][3]

Ontario's chiropractic standard uses the “as low as reasonably achievable” principle for radiation dose and says the number of views should be based on clinical indications.[1] The goal is not to avoid needed imaging.[1][3] It is to use imaging when the result can answer a useful clinical question.[1]

What should you ask if an X-ray is recommended?

Useful questions include:

• What finding are you trying to confirm or rule out?
• How could the result change the diagnosis or care plan?
• Are recent images or reports already available?
• What are the benefits, limits, and radiation risks?
• Are there alternatives, or is it reasonable to monitor first?
• Where will the imaging be obtained, and how will the result be reviewed?

The chiropractor should explain the reason and process, and the rationale should be recorded in your health record.[1]

Can you decline an X-ray or ask more questions?

Yes. Consent should be informed, voluntary, and connected to your condition and circumstances.[2] The discussion should cover the proposed examination or care, expected benefits, material risks and side effects, alternatives, and what may happen without it.[2]

You can ask questions before agreeing, and you may withdraw consent at any time.[2] Declining an X-ray may affect what can be assessed or offered safely, so ask the clinician to explain the practical options for your situation.[1][2]

How can Markham Pain Clinic help?

Markham Pain Clinic lists chiropractic care for spine, joint, and mobility concerns. Learn about the service: https://www.markhampain.com/services/chiropractic-care

To ask about an assessment or appointment availability: https://www.markhampain.com/contact https://markhampainclinic.janeapp.com/

Markham Pain Clinic 8312 McCowan Rd Suite #206 Markham, ON L3P 8E1 +1 905-470-2626

Frequently asked questions

Does every first chiropractic visit include X-rays?

No. Ontario's standard says radiographs should be ordered when the history, examination, or diagnostic tests indicate that imaging could clarify a finding.[1] The decision is individual rather than automatic.

Can chiropractic care begin without an X-ray?

Sometimes, depending on the assessment and the proposed care.[1] In other situations, imaging or a referral may be needed before care proceeds.[1] Ask what information is missing and how the result would change the plan.[1]

Should I bring old X-ray reports to the appointment?

Yes, if they are relevant and available. Ontario's standard asks chiropractors to make reasonable attempts to avoid unnecessary duplication and to consider recent radiographs when appropriate.[1]

Does an X-ray show the cause of all back or neck pain?

No.[1] An X-ray shows certain structures, especially bone, but it does not explain every symptom.[1] The result should be interpreted with your history, examination, and other clinical information.[1]

Medical disclaimer

This article is for general education and is not medical advice, a diagnosis, or a recommendation for or against imaging. Whether an X-ray is appropriate depends on an individual history and examination. Speak with a qualified healthcare professional about your symptoms, pregnancy status, past imaging, medicines, and treatment options. Seek urgent care for severe, sudden, or rapidly worsening symptoms.

Sources: [1] https://cco.on.ca/wp-content/uploads/2024/10/S-006Feb2024clean.pdf — College of Chiropractors of Ontario: Ordering, Taking and Interpreting Radiographs [2] https://cco.on.ca/wp-content/uploads/2024/10/S-013Feb2025-1.pdf — College of Chiropractors of Ontario: Consent Standard [3] https://choosingwiselycanada.org/common-tests-treatments-procedures — Choosing Wisely Canada: Common Tests, Treatments and Procedures