x-rays, chiropractor, chiropractic, imaging, choosing wisely, aca

Do I Need To Get X-rays When I Go To A Chiropractor?

New thinking from chiropractor in Amarillo TX

For generations, it has been well-recognized that chiropractors take x-rays. In fact, chiropractors are trained to read x-rays in school at a level no general medical practitioner is taught. In some cases, they take A LOT of x-rays. However, as with anything else in health care, as more is learned through research, common practices are often reassessed and updated when necessary. Taking x-rays is a prime example of this as they are currently being cussed and discussed at the highest levels of the profession. 

Basically, as it seems to be with just about everything in the chiropractic profession, there are two camps. One supports the use of x-rays to determine safety of treatment, type of treatment, and then shooting several x-rays periodically throughout treatment to ‘validate’ the treatments effectiveness. On the other end of the spectrum, you have chiropractors that are on board with the newer research, evidence, and recommendations. 

One of the largest uproars in the profession came about approximately 3 years ago in 2017 when the largest chiropractic organization in America, the American Chiropractic Association (ACA), presented their new recommendation program called Choosing Wisely. Basically, the ACA said to avoid routine spinal imaging in the absence of clear clinical indicators for patients with acute low back pain of fewer than six weeks duration. According to the ACA, ‘clear indicators’ were conditions like history of cancer, fracture or suspected fracture progressive neurologic symptoms, and infection. Not to mention other complicating factors like osteopenia, osteoporosis, tumors. 

They argue that unnecessary imaging means more money, exposes the patient to ionizing radiation and can result in labeling patients with conditions that are not clinically meaningful giving them some false sense of being vulnerable or fragile when the truth is, they’re usually just normal. 

The ACA goes on to recommend against repeated imaging to monitor a patient’s progress. They say that currently there is no information available to support a relationship between changes in alignment or other structural characteristics and patient improvement. Again, repeated x-rays raise the cost of care for the patient, expose the patient to unnecessary radiation, and may distract from more meaningful outcomes. Not to mention there are no known connections between performing routine or repeated x-rays to monitor a patient’s condition and improved clinical outcomes or meaningful changes in patient management. They say we should only need repeated x-rays if there is some distinct change in the condition, symptoms are worsening, or things of that nature. Otherwise, repeated x-rays are not on the menu. 

Now, with all of that said, put yourself in the shoes of a chiropractor for just a second. If you had a new patient that came in hurting and they wanted you to ‘pop’ some bones and move things around but you don’t know anything about them or what they have previously put themselves through, how comfortable would you be going in blindly with no x-rays? Some chiropractors are very comfortable in doing so. Some chiropractors are not comfortable at all with this scenario. 

I have a hard time finding fault in chiropractors in Amarillo choosing to have x-rays on many of their new patients. Your doctor needs to be comfortable and confident in their treatment. At my chiropractic office, I personally require x-rays only when there are significant red flags. The most common red flag is ‘traumatic onset’. If a person had a fall, bumped their head, or was in a car wreck, those are the very definition of ‘traumatic onset’ and I will want x-rays in cases like that. 

Other red flags might include history of cancer, night pain, fevers, unexplained weight loss, corticosteroid use, failure to respond to care after 4 weeks, or progressive loss of neurological function. Outside of issues like these, I do not typically require x-rays to come see me at my Amarillo chiropractic office. 

There is even recent research that hypothesizes that repeated x-rays may be a cause of neurodegenerative diseases(Rodgers C 2020). My opinion is this; if there is no research to back up the use of repeated x-rays or requiring x-rays outside of red flags, why not err on the safe side and not take them outside of the presence of red flags?

Some of this comes down to common sense. For example, if you are young, have had no accidents or trauma or health issues, and wake up one day with a sore neck, do you think you need x-rays if you go to the chiropractor? 

The research and guidelines say, “Probably not.”

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Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast. Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected]

 

Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109

 

Bibliography

Rodgers C (2020). "Low-dose X-ray Imaging May Increase the Risk of Neurodegenerative Diseases." Med Hypotheses 142(109726).