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Beware of Unnecessary X-Rays?

In times past, it was customary for chiropractic patients to receive x-rays of their spine before having chiropractic care.  These days the latest evidence does not recommend the need for routine x-rays as it may re-inforce harmful beliefs regarding a patient’s pain. In a 2017 editorial in The British Journal of Sports Medicine entitled, “It is time to stop causing harm with inappropriate imaging for low back pain.”, the authors state that unnecessary imaging can be detrimental in 3 ways.:

  1. Misinterpretation of results by clinicians resulting in unhelpful advice, needless subsequent investigations (downstream testing) and invasive interventions, including surgery;
  2. Misinterpretation of results by patients resulting in catastrophisation, fear and avoidance of movement and activity, and low expectations of recovery;
  3. Side effects such as exposure to radiation.

While imaging  provides a detailed description (at least with MRI) of a person’s spinal structures, so-called abnormal findings are increasingly prevalent with age in asymptomatic populations  and correlate poorly with a person’s level of pain and disability.

Patient interpretation of images, the accompanying report and explanation of their meaning can lead to beliefs that their spine is damaged and structurally vulnerable, resulting in fear and subsequent avoidance and protective behaviours.

Furthermore, another paper written in 2018 was also warned us away from routine imaging. The article by  Jenkins et al, Current evidence for spinal X-ray use in the chiropractic profession: a narrative review states  “ in the vast majority of cases who present to chiropractors, the potential benefit from spinal X-rays does not outweigh the potential harms. Spinal X-rays should not be performed as a routine part of chiropractic practice, and the decision to perform diagnostic imaging should be informed by evidence based clinical practice guidelines and clinician judgement.”

At Farrelly Chiropractic we will not order imaging initially unless we deem a need for it.  This will sometimes occur if you progressive weakness of muscles strength and your condition is worsening over time.  When this occurs we will send you for an MRI as this shows far more detail of discs and other soft tissues not seen on x-ray.  If we feel that you may have a compression fracture, coccyx fracture or hip which is degenerating you may be sent for x-rays.

References:

Darlow, B., Forster, B. B., O’Sullivan, K., & O’Sullivan, P. (2017). It is time to stop causing harm with inappropriate imaging for low back pain. British Journal of Sports Medicine, 51(5), 414–415. http:// doi.org/10.1136/bjsports-2016-096741

Jenkins et al. Chiropractic & Manual Therapies (2018) Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. 26:48 https://doi.org/10.1186/s12998-018-0217-8