Chronic low back pain is a common condition that becomes even more prevalent with age. By some estimates, it may affect nearly 3 in 4 older adults each year. As individuals aged 65 and older continue to make up a growing share of the global population, chronic low back pain will remain a significant healthcare concern. Given the risks associated with surgery and medication side effects, many seniors prefer a non-surgical, non-pharmacologic approach to managing their pain—leading them to seek chiropractic care.

X-rays may or may not be used during an examination, which can sometimes cause confusion for patients. Many are surprised to learn that one of the primary uses of X-ray in chiropractic care is not to help decide if a patient may not be a candidate for chiropractic treatment. If a patient’s history or symptoms include significant trauma, a history of cancer, osteoporosis, prolonged corticosteroid use, infection, high fever, worsening pain at rest, neurological symptoms, sudden deformity, or a palpable mass, an X-ray may be warranted. In such cases, imaging helps identify fractures, severe osteoporosis, tumors, infections, or other serious conditions that require referral to a specialist or emergency care.

Absent red flags, most clinical guidelines do not recommend X-rays for uncomplicated chronic low back pain in older adults. Not only can this avoid unnecessary radiation exposure, but many older adults have incidental findings on X-ray—such as disk degeneration, disk herniation, or scoliosis—that may not be the primary cause of their pain. Focusing on these findings could lead to unnecessary and ineffective treatment with the patient continuing to experience ongoing pain and disability.

Interestingly, many spine-related complaints in older adults do not have a clear structural cause, meaning the pain may not be visible on X-ray. This underscores the importance of chiropractors performing movement-based assessments to identify soft tissue dysfunction that may be contributing to the patient’s pain. By replicating the motions that provoke discomfort, chiropractors can gain valuable insights into muscular, ligamentous, and fascial contributions to the patient’s chief complaint, allowing for a more targeted care plan.

Fortunately, many cases of chronic low back pain in older adults respond well to a multimodal treatment plan that incorporates manual therapies, targeted exercises, therapeutic modalities, patient education, and nutritional support. This approach not only helps reduce pain but also improves mobility, function, and overall quality of life.