Over the last three decades the evidence for diagnosing spinal pain has moved from a static approach (for example, x-rays) to a more dynamic, patient centered approach. This involves a variety of different factors including looking at how we move, muscle tension, orthopedic testing, stress, ergonomics, etc.
This transition, combined with an increased awareness of the associated risks of radiation exposure from x-rays, has led to a decrease in the use of x-rays to evaluate spinal pain.
When Are X-Rays Recommended?
Current evidence supports the use of x-rays only for diagnosis in a select few circumstances…
- Underlying Disease
- Serious Trauma
These conditions are actually rare causes of spinal pain and therefore routine use of x-ray to diagnose them in chiropractic practices is not recommended. Additionally, MRI and blood tests are the preferred investigation method when a serious disease is suspected.
If you’ve had serious trauma or if an underlying disease is suspected during your initial examination our doctors will refer you back to you medical doctor for further investigation and appropriate testing.
Why Routine X-Rays Are Not Appropriate
There is strong evidence that demonstrates the risks of routine imaging such as excessive radiation exposure, over diagnosis, low-value investigation and treatment procedures, and increased costs to you, the patient.
In most cases the potential benefits from routine imaging do not outweigh potential harms. According to current evidence, the use of spinal x-rays should not be routinely performed in chiropractic practices. Instead, they should only be performed when there is an indication for them during your care.
Finally, based on current research, the use of routine x-rays in chiropractic care does not improve your treatment outcomes or safety and they have not been found to be a useful way to determine the site of chiropractic adjustments.
What does this all mean to you as a patient?
Basically, routine x-rays will not improve your treatment outcomes or allow for safer care. Chiropractic care is very safe and our chiropractic team is highly trained to diagnose and treat you based on our comprehensive clinical history and physical examination, without exposing you to unnecessary harmful radiation.
It’s important that we continue to reduce low-value care, including avoidable and wasteful tests and procedures. Routine x-rays fall into this category and are a needless out of pocket expense to you, the patient; not to mention the risks of unnecessary radiation exposure.
Current Evidence for spinal x-ray use in the chiropractic profession: a narrative review. The Journal of Chiropractic & Manual Therapies. 2018 Nov 21. Hazel J Jenkins, Aron S Downie, Craig S Moore and Simon D French. www.ncbi.nlm.nih.gov/pmc/articles/PMC6247638