X-rays are a type of electromagnetic energy wave. When you have an X-ray, an X-ray sensitive film (i.e. a film that absorbs X-rays) is placed behind you, and when the X-ray is taken your bones/metal absorb more of the X-ray than your soft tissue. Therefore, X-rays pass through your soft tissue more than bone and you see a picture of the silhouette of your bones on the film - so X-rays only show bone. Therefore, they will only show arthritis, fractures (breaks) and dislocations. They will not show muscle/disc/ligament problems. This could be the reason why your doctor may not refer you for an X-ray. Even if an X-ray comes back normal, it does not mean that there is not a problem with structures other than bone. Likewise, if an X-ray shows bony changes there could still be some other soft tissue problems.

MRI scans (Magnetic Resonance Imaging) differ from X-rays as they use magnetic and radio waves. They can be used to see images of almost all the body’s tissues, i.e. they show soft tissues as well as bone. They are therefore, much more useful than an X-ray. However, if a clear diagnosis has been reached by your therapist/doctor they may decide that there is no need for a scan because it will not change your treatment.

CAT scans also use X-rays, but they scan from all different angles unlike normal X-rays. The information gained is then passed into a computer which combines all the information to make a detailed picture of the body. CAT scans show all tissues in the body, not just bones, as they use different detectors to pick up how much of the X-ray is passed through the body (not just a plain film as in normal X-rays).

DEXA Scans (DXA scans or Bone Density Scans) are indicated if your doctor is concerned that you may have osteoporosis. Osteoporosis itself is painless so it should not be the cause of your neck/back pain.

Blood tests are only useful if your doctor suspects there may be another reason for your pain. For example, your white blood count may be raised if you have an infection. Rheumatoid factor is an antibody found in the blood of people with rheumatoid arthritis. Your doctor may suggest a blood test to rule out other causes of pain.
Chartered Society of Physiotherapy Manipulation Association of Chartered Physiotherapists Physio First Association of Chartered Physiotherapists in Orthopaedic Medicine Society of Orthopaedic Medicine Acupuncture Association of Chartered Physiotherapists