Wednesday, 23 July 2014

X-Rays: Do Chiropractors Need Them?

X-rays or diagnostic images play a critical role in chiropractic care. X-rays help chiropractors evaluate the health of your bones to reach an accurate diagnosis. However, it is important to make sure you're working with a reputable chiropractor who is taking x-rays for the right reasons.

A chiropractor who insists on taking x-rays on every single patient, regardless of the issue at hand, should raise an immediate red flag. Most general pain treatment does not require x-rays. You should also be weary of a chiropractor who compares an “imperfect” patient x-ray to a “textbook” spine as justification for long-term treatment. Your ultimate goal of chiropractic care is not to have a spine that is perfect anatomically.
It is also important to keep in mind that it is common for an x-ray to indicate spine issues even when a patient is not exhibiting symptoms. If you are not in pain and your chiropractor recommends starting or continuing treatment based on the x-ray, consult with another chiropractor or other medical professional. The same principle is true for MRI scans and other imaging.

Importance of X-Ray for Chiropractor
A General Guideline
X-rays are advised for the following situations if the health care provider believes that the imaging will provide insight for the treatment plan, including direct treatment protocols and/or referral options.

  • If there is an infection that may be related to the patient's pain
  • If the patient has sustained a traumatic injury, such as a dislocated joint or a broken bone
  • If any type of joint disease is suspected (i.e. gout causing joint pain)
  • If any severe disease is suspected, such as cancer
  • If the patient is age 50 or older and has experienced any type of trauma, regardless of the severity
  • If the patient is age 65 or older
  • If the patient has been diagnosed with or is highly susceptible to osteoporosis, as an x-ray could pinpoint or rule out a potential fracture resulting from osteoporosis
  • If the patient may have spinal instability
  • If the patient has chronic pain that has been unresponsive to or unresolved with prior treatment
  • Most of the previously mentioned scenarios do not apply to individuals who are seeking chiropractic care. Typically if the chiropractic patient is under age 65 and experiencing general musculoskeletal lower back pain, an x-ray is not needed.

An x-ray should never be performed under the following circumstances:

  • To identify issues within the spinal disc itself or with soft issues (tendons, muscles, ligaments). X-rays are effective for identifying joint and bone pathology but not soft tissue pathology. If you and/or your health care provider believe that soft tissue is at the root of the issue, an MRI should be ordered.
  • Simply for exploratory purposes. Most health care professionals wait to order x-rays and other imaging until they have a good idea of the cause of the patient's pain. An x-ray should be used to confirm an idea, not to form an original idea.

Additionally, if there is any possibility that you could be pregnant, do not undergo an x-ray. Inform your chiropractor or other health care provider about your pregnancy and discuss alternative diagnostic options.

X-Ray Exposures
One of the biggest questions that patients have about x-rays is whether or not they are dangerous. There is always a slight risk from exposure to x-rays, which health care providers take into consideration when they order them. Younger individuals are at a higher risk than older people because x-ray exposure can take years to develop. X-ray machines in reputable medical facilities are inspected periodically to ensure that they meet national radiation protection board standards. Chiropractors use special kinds of x-ray film and screens that significantly reduce radiation dosage.

Modern View
While an x-ray does contain radiation, the modern dosage is a fraction of what it was just 30 years ago. Medical professionals who choose to order x-rays for their patients believe that the potential benefit of the imaging outweighs the potential risk. For example, if you broke your foot, you want the doctor to have a clear picture of the damage before proceeding with setting the foot and molding a cast.

Doubt? Take a Second Opinion
The bottom line is that x-rays can be a key for identifying and/or ruling out specific pathology and guiding the treatment plan when they are used properly. However, most general back pain treatment that a chiropractor performs does not warrant them. If you're ever in doubt about why you are getting chiropractic x-ray, don't be afraid to talk to your chiropractor about it, and even get a second opinion.