Do I need an X-ray?
Radiographs or X-rays are an enormously helpful tool in clinical setting both acute and chronic. Often X-rays are overused both by MD’s and Chiropractors. There are specific rules for all the areas of the body and criteria for X-rays. Probably the easiest to explain is the Canadian Cervical spine rules. These rules are put in place to evaluate if a patient has clinical reasoning for an X-ray. You start with: is the patient over 65 or did they have trauma. If they meet either of those criteria then X-rays are validated. If they don’t meet that criteria there is a second subset of criteria stating: simple rear end MVA, ambulatory, delayed onset neck pain. If they meet those criteria you move on to whether the patient can rotate their head to each side 45 degrees. If the can rotate their head then no X-rays are warranted. If at any time they don’t meet the criteria in the subset then X-rays are warranted.
There are different rules for different parts of the body but I think you get the jest of it. Many MD’s and Chiropractors take an X-ray if you come in having neck pain or low back pain. This can cause unnecessary radiation to the patient (although normally negligible) and a burden on the healthcare/patient cost. If we simply used the X-ray rules in place we could save millions in unnecessary X-ray cost and ultimately that could drive down Health insurance.
Many Chiropractors use a technique called Gonstead as a means of recognition of the vertebrae that need manipulation. This is often unnecessary. Motion palpation and a Physical examination will give you a great understanding of where joint manipulation should be focused. Using a static picture (X-ray) to find out how something is moving dynamically doesn’t really make sense anymore with our current understanding of joint manipulation. If you do visit a chiropractor practicing Gonstead and they take an X-ray before treatment, they should also take on after the treatment plan and compare to initial (adding cost and unnecessary radiation).
Of course there are times when the rules will not apply and the practitioner should get and X-ray. One cannot 100% rely on a paper rule guideline for an individual patient. This is where the skill of the Doctor comes into play and the saying “when in doubt, rule it out”. The point I’m trying to make is that often time X-rays are not warranted and it is an easy way for some providers to get a patient out of their office because they don’t know what is going on/x-ray looks fine (spines are very tough it can be very unclear what is causing pain). The other way it can be spun is that the provider is trying to manipulate the patient because the X-ray doesn’t look perfect and symmetrical (which is rare among healthy people)Thus scaring the patient into a long treatment plan.
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