Back X-rays vs. Functional Ability Tests

This should be scheduled after the post-offer drug screening test results are received and after a physical examination has been performed–in that order.

For the past 20 years, Cooper Clinic Occupational Medicine has been educating businesses that there is no need to perform a post-offer x-ray of the back. This is because a back x-ray does not accurately indicate whether or not the prospective employee will be able to perform the essential functions of the job. Occasionally, what it might reveal is that the patient has actually undergone back surgery but denied having said procedure. However, simply removing the patient’s shirt, during the physical examination, is a more direct and cost-effective approach.


Several years ago an employer requested a back x-ray for a prospective employee. The man’s excessive weight, however, was more than a standard x-ray table could handle and the x-ray could not be administered. Scheduled for a functional lift test, he declined.

The man also declined the job offer. It had become apparent that, despite his previous denial, the prospective employee had undergone microdiscectomy back surgery. It had left a well-healed and virtually hidden scar. The man had not wanted to risk a recurrence of pain and impairment from the functional test. This is one example of how applying the principle of Form Follows Function can help save clients when facing future large indemnity claims.

The three-step process of getting the drug screen result first, then the physical examination, followed by a job-specific functional test is very important. It has been applied successfully for decades in matching the prospective employee to the job. An added bonus is that this information can be used prospectively to compare with future performance during a return to work examination after an injury or illness. After an injury, the form might be changed, such as during an arm or hand injury, but the functional ability remains preserved.

Form Follows Function. This is one of the guiding principles at Cooper Clinic. It is a general engineering principle that also applies to occupational health.


Dr. Holder joined Cooper Clinic in 1997 and established the Occupational Medicine Department. A graduate of the University of Arkansas School of Medical Sciences, Little Rock, he completed his Occupational Medicine residency at Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. Holder is Board Certified by the American Board of Preventive Medicine specializing in Occupational Medicine.

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