So today I was asked why the clinic do not have x-ray facilities and why I do not routinely take x-rays a question that I have been asked many times in my career both when I have been working for other chiropractic practices that do not take x-rays and in our own practice.
There is no real simple answer to this so I have decided to break it down….
X-rays are a diagnostic tool – this means that we take an x-ray in order to diagnose an under lying issue, and if we are concerned of an underlying issue we should be getting the best x-rays we can and having these read by a radiologist (or a chiropractic radiologist).
Many chiropractic practices take x-rays of every client they see, and while this model has been acceptable for some time it is not the correct way x-ray was supposed to be used by chiropractors, if your chiropractor is taking an x-ray to look for the ‘vertebral subluxation’ is not only harmful to your health (unnecessary radiation) but also a waste of time as the x-ray is a moment in time and will change with the next stressor your body encounters.
In our practice, except in special cases, when there are red flags (serious symptoms to suggest fracture, bone disease, cancer or other serious problems) x-ray examination is rarely necessary in the first month or back or neck pain, if we find that there are red flags or underlying issues not related to our clients spinal health we happily refer them on to the appropriate career and when we do request x-rays these are taken at the radiology department at Masterton Hospital or through partners such as Pacific Radiology, we then have access to the x-rays and a report that has been read by an experienced radiologist.
We also communicate all x-rays with our client’s primary health career and will refer back if there is any issue that is not related to their spinal health.
I also often get told – ‘my last chiro drew lines on the film to tell me what was wrong’ - I too will do this if needed or if I need to work out a scoliosis but this is not what I am adjusting – the primary thing we are looking for is lack of function and while we can see changes in function on the x-ray that does not always match what the physical exam findings will show us – this is why I use a technique called Thompson as this allows me to look at function and symptoms and adjust accordingly.
‘But surely I will get a better result if you take an x-ray?’ Several studies have shown that imaging does not improve clinical outcomes in patients with lower back pain and in fact the American College of Radiology states in it appropriateness criteria (2015 – Appropriateness Criteria, American College of Radiology) ‘for a patient with Low Back Pain (defined as acute, subacute or chronic uncomplicated low back pain or radiculopathy. No red flags. No prior management), a general x-ray or MRI of the whole lumbar spine is generally not appropriate” they conclude that imaging on the whole is not warranted in the diagnosis or treatment of these cases. It has also been found that imaging in many cases will precipitate interventions that do not improve outcomes and x-ray and MRI’s early in treatment may lead to higher costs, more tests and care that do not ultimately help the patient’s condition.
‘But I have been told I have degeneration and the x-ray shows this…’ this is perhaps the most frustrating for me – you have used your body – sometimes not appropriately and there will be degeneration on your film even in those who do not have ‘pain’ however often these findings are completely unrelated to your pain and are in fact even normal. It can also be difficult to tell what is old and what is new damage unless it is an actively healing, and as we age anatomical changes are a normal part of our lives and do not always cause pain.
So I chose to listen to my clients, ask them what is going on in this amazing tool that carries them around every day as they are the best source of knowledge as to what is going on in their bodies, test their function, change the type of treatment and reassess as we need to, and if we do not see the result we want or there are other factors of concern I choose to refer on for specialized diagnostics which at times will include x-rays and other imaging.
If you ever wish to talk to me about this please do not hesitate, I am not saying taking x-rays is unnecessary and in fact I strongly believe that there are times when they are the best course but I will not take them on everyone and I do not treat to x-rays.
Wednesday 5th of September 2018
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