MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

I have long cautioned that chiropractic overuse of X-rays is a safety problem. Is this still an issue? A recent paper was aimed at finding out.

The objective of this review was to determine the diagnostic and therapeutic utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. Investigate whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. The research objectives required that the researchers determine the validity, diagnostic accuracy and reliability of radiographs for the structural and functional evaluation of the spine.

The investigators searched MEDLINE, CINAHL, and Index to Chiropractic Literature from inception to November 25, 2019. They used rapid review methodology recommended by the World Health Organization. Eligible studies (cross-sectional, case-control, cohort, randomized controlled trials, diagnostic and reliability) were critically appraised. Studies of acceptable quality were included in our synthesis.

Twenty-three papers were critically appraised. No relevant studies assessed the clinical utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. No studies investigated whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. Nine low risk of bias studies investigated the validity (n = 2) and reliability (n = 8) of routine or repeat radiographs. These studies provided no evidence of clinical utility.

The authors’ conclusions are clear: We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.

In the paper, the authors provided further valuable information and background:

In the United States in 2010, the rate of spine radiographs within 5 days of presenting to a chiropractor was 204 per 1000 new patients. An analysis of national trends in the United States suggests that the rate of spinal radiography by chiropractors and podiatrists increased by 14.4% between 2003 and 2015. This increase occurred despite the publication of several evidence-based clinical practice guidelines and clinical prediction rules to assist chiropractors in determining the indication for spine radiographs to assist with diagnosing a pathology. Overall, guidelines suggest that radiographs are indicated when signs and symptoms of potentially serious underlying pathology (red flags) are identified through the clinical history and physical examination. However, on its own, an isolated “red flag” may have a high false positive rate for the diagnosis of underlying spinal pathology, such as cancer. For example, the presence of a solitary “red flag” such as age over 50 years may not be sufficient to warrant taking spine radiographs. Therefore, clinicians are encouraged to combine sound clinical judgement and the assessment of red flags when ordering radiographs.

In the absence of “red flags”, the use of spinal radiographs is not recommended. Nevertheless, factions of chiropractors, including the International Chiropractic Association promote the use of routine or repeat radiographs to assess the structure and function of the spine. This practice which dates back to 1910 was initiated when no evidence was available to guide the judicious use of spine radiographs. Historically, these groups of chiropractors have argued that radiographs are helpful to measure postural abnormalities, identify vertebral misalignment or subluxation and guide treatment with spinal manipulative therapy. The belief that radiographs are useful to detect and correct spine structure and function provides the foundation for many chiropractic technique systems that are still in use today. To our knowledge, approximately 23 chiropractic techniques use spine radiography (including full spine radiography) to guide the clinical management of patients. These include the Gonstead, Chiropractic BioPhysics®, Toggle-Recoil, and National Upper Cervical Chiropractic Association (NUCCA) techniques. Proponents of these techniques claim that the use of routine and repeat radiographs is supported by scientific evidence and have published a guideline to assist clinicians with the biomechanical assessment of spinal subluxation in chiropractic clinical practice using radiography. However, these claims have not yet been evaluated for their clinical utility, the benefit a patient gains from a test or treatment. This was a particular concern for the College of Chiropractors of British Columbia (CCBC) which regulates the practice of chiropractic in the province of British Columbia, Canada. The mission of the CCBC is to protect the public by regulating British Columbia’s doctors of chiropractic to ensure safe, qualified and ethical delivery of care.

The references from these two paragraphs can be found in the original paper. One reference the authors did not include was my article of 1998 which, at the time, received plenty of angry responses from chiropractors. Here is its conclusion: DATA SUGGEST AN OVERUSE OF RADIOGRAPHY BY THE CHIROPRACTIC PROFESSION. THIS CONSTITUTES A SAFETY PROBLEM THAT DESERVES TO BE TAKEN SERIOUSLY AND REQUIRES FURTHER RESEARCH.

Twenty-two years later, do I get the impression that the chiropractic profession might not be the fastest in getting its act together?

45 Responses to The clinical utility of routine spinal radiographs by chiropractors

  • The same considerations apply of course to the use of spinal radiology by MDs.

    As an orthopaedic surgeon who operated on spines, my approach was that in the absence of very clear indications (such as red flags), there was no purpose to having an XR, and ionising radiation is to be avoided.

    Any diagnosis should be made on the history and examination. An XRay may then be useful to identify the specifics for surgical attention: Radiology should be used to indicate where to operate, not whether to.

    The indication for the use of radiology by chiropractors is to enhance their image, massage their egos and convince the gullible and vulnerable that they are ‘doctors’ and in some way equivalent to MDs – a profession they did not join.

    • yes, of course!
      when I was a junior doctor looking after back pain patients, many came with heavy files of X-rays. since then, the medical profession has learnt that X-rays are only indicated under certain well-defined conditions. the chiropractic profession seems to be much slower to learn this lesson.

      • @EE
        “the medical profession has learnt that X-rays are only indicated under certain well-defined conditions”
        Forgive me for laughing. Overuse of imaging, especially advanced imaging is a major issue in medicine and on the rise.
        I recommend you read this recent paper:
        How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years
        Aron Downie, Mark Hancock, Hazel Jenkins, Rachelle Buchbinder, Ian Harris, Martin Underwood, Stacy Goergen, Chris G Maher. BJSM. 13 Mar 2019. Doi: 10.1136/bjsports-2018-100087

        • “In the United States in 2010, the rate of spine radiographs within 5 days of presenting to a chiropractor was 204 per 1000 new patients.”

          Heck, do MDs even come close to that percentage? Who was the motivation for the Choose Wisely when it came to imaging?

          “To our knowledge, approximately 23 chiropractic techniques use spine radiography”

          Out of how may Techniques? Over 200?

          • @DC
            Recent paper on Choosing Wisely:
            Do choosing wisely recommendations about low-value care target income-generating treatments provided by members? A content analysis of 1293 recommendations.
            https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4576-1

            “Choosing Wisely recommendations are framed in ways that lessen potential impact on the members of the society making the recommendation. Only 20% of treatment recommendations refer to income-generating treatments, and these are less likely to target members compared to non-members. Although nearly half of Choosing Wisely recommendations are qualified, qualified statements were not more likely to appear in recommendations targeting income-generating treatments that apply to members. Societies need to generate recommendations that specifically target the practice of members, and reduce, if not eliminate, qualified recommendations from Choosing Wisely.”

            In medicine it’s a case of “Choose (someone else) Wisely” and leave my cash cows alone. 😉

            Recently in Australia referral rights for chiro’s for three region (full spine) xrays were withdrawn. We can only refer for two regions at a time now.
            Years ago when xrays went digital medical radiologists realized that chiro’s were taking xrays and told us to send them the xrays and they will do the report. The government pays the medical radiologists $160 for the report and this also covers the cost of taking the xrays. So the medical radiologists told chiro’s we will pay you $100 to cover the cost of taking the xray and we will keep $60 for the report. The good time$ rolled and this went on for a few years.
            The government notices high rates of chiro’s ordering full spinal xrays and we were warned.
            The government stopped paying the medical radiologists if the radiographer was a chiro. So the medical radiologists sent the own radiographers into the chiro’s clinics and payed the chiro’s “RENT” for the facilities and the full spinal xray$ kept coming.
            Govt then withdrew chiro’s rights to refer for full spinals. Did they audit the chiro’s to see who was generating excessive full spinal referrals? Nope.
            Guess what the medical radiologists then did?
            Reprinted their referral pads and added a tick box “chiropractic xrays”.
            They take full spinal$ but bill public health (Medicare) for two regions only.
            Wonder who’s the problem?

        • In patients referred for lumbar imaging, 34.8% (95% confidence interval [CI]: 27.1, 43.3) were judged inappropriate by the absence of red flags for serious pathology and 31.6% (95% CI: 28.3, 35.1) were judged inappropriate by the criteria of no clinical suspicion of pathology.

          https://www.thespinejournalonline.com/article/S1529-9430(18)30203-1/fulltext

  • When I was a boy in the 1960s, the Co-op Shoe Shop had a Pedoscope foot X-Ray machine. It wasn’t in use by then, but I wonder how many feet were X-Rayed in the late 1950s. https://www.theoldie.co.uk/blog/what-was-a-pedoscope

    My late father was wounded in the Normandy D-Day landings and had a lot of hospital treatment. I have a handwritten list he made of the various treatments over a couple of years. Among them was something called “Deep X-Ray Treatment”. I found a 1940s BMJ article about this – it was thought to speed up tissue healing. My father died of Acute Myeloid Leukaemia in 1980. Who knows if there was any connection….

    And let’s not start on luminous watch dials! “Radiation” has very much changed in its connotations. I picked up in a charity shop, a 1930s cookbook, really an advert for electric ovens, and it’s called The Radiation Cookbook, simply referring of course to radiant heat. I don’t think a cookbook of that title would sell too many copies today! Unless it was being ironic in some way.

    My local dentist is excellent “The home of pain-free dentistry” (I told them they had just transferred the pain to the wallet). It is striking how short the exposure time is for modern digital-imaging dental X-Rays compared to the 1970s – and how carefully the staff keep out the way even for those tiny-duration exposures.

    • David B,

      When I was a boy in the 1960s, the Co-op Shoe Shop had a Pedoscope foot X-Ray machine.

      I remember seeing one of those in my local shoe shop, too, though I have no idea whether it was still in use.

      Among them was something called “Deep X-Ray Treatment”.

      Deep x-ray treatment is a form of radiotherapy, and indeed radiotherapy is still often abbreviated as DXT. It is named in contrast to superficial x-ray treatment, which is also radiotherapy, but for treating the skin. The difference is in the energy of the x-rays, with superficial x-rays in the range 20 – 100 KV and deep (these days referred to as orthovoltage) x-rays being several hundreds of kilovolts. This refers to the voltage applied across the x-ray tube, which is something like a cathode ray tube with a tungsten target which emits a spectrum of x-rays when the accelerated electrons hit it. The lower energies are filtered out by sheets of aluminium or copper

      Even deep x-rays don’t penetrate particularly deeply as most of the energy is deposited just below the skin, meaning that several beams applied from different directions were needed to achieve the required dose at depth (with the beams crossing at the target volume). You can usually tell if somebody has had this sort of treatment as the high skin dose leads to characteristic scarring.

      A better alternative was to use gamma rays, usually from a cobalt-60 source, which are higher energy and penetrate further. It is not at all practical to generate x-rays in the megavoltage range from a conventional x-ray unit as air becomes conductive at these voltages (which is why electricity sub-stations have so many warnings to trespassers – you don’t need to touch them to get a fatal shock if the electricity can jump out at you). These days radiotherapy is usually given using linear accelerators, with typical beam energies in the range 6 – 15 MV. The beam delivers very little dose to the skin as it enters, though there can be a higher exit dose, particularly if there is back-scatter from the treatment table; thus there is much less scarring. Current radiotherapy techniques involve detailed computer simulation of exactly how the dose is distributed, and also computer-controlled delivery using multiple beams that are shaped and partially shielded during the treatment, which enables precise treatment of irregularly-shaped volumes while at the same time avoiding critical normal structures.

      I found a 1940s BMJ article about this – it was thought to speed up tissue healing.

      Radiotherapy isn’t used very much for benign conditions any more because of the risk of inducing tumours. It would have thought it would slow down tissue healing, not speed it up, but it is very good at reducing local inflammation, I suppose because inflammatory cells (lymphocytes and other white blood cells) are particularly sensitive to radiation. It is still used occasionally to deal with scarring in people whose skin forms keloid (a form of exuberant and ugly scarring), palmar and plantar fasciitis and certain kinds of inflammatory joint problems.

      When I was a radiotherapy registrar, I saw a man with a very strange inflammmatory condition affecting his fingertips called acrodermatitis continua. The referring dermatologist had tried everything and had read somewhere that radiotherapy could be helpful. When I presented the case to my consultant, he asked me what the current thinking was on this condition, and I had to admit that I had never heard of it; nor had he. He decided to ask a more experienced colleague, Dr Bill White, who had a reputation of having seen it all. Bill examined the patient, who said:
      “It started on this finger here, then on that toe. Then it spread to that toe over there, and finally this finger. But you know what is so odd? I’ve only every had it on the left side.”

      Bill White replied:
      “That’s very characteristic of this condition. All the cases that I have seen have been on the left.”
      He then recommended a radiation dose schedule to try.

      Afterwards my consultant, who was as impressed with Bill’s knowledge as the patient had been, asked:
      “How many cases of this have you seen over the course of your career?”

      “Just the one…”

      I followed him through his treatment, which involved making special wax blocks to fit around his hands to even out the dose, and the radiotherapy was completely successful where all else had failed.

      My father died of Acute Myeloid Leukaemia in 1980. Who knows if there was any connection….

      Of course it is impossible to know in an individual case. Radiation dose limits for classified workers are set on the basis that working with radiation should be safer than any other industrial hazard, i.e. fewer than 1 excess cancer death in 20,000 resulting from a year’s exposure. The data from Hiroshima and Nagasaki suggest that a total body dose not quite enough to kill you gives about a 1 in 1,000 chance of an additional cancer over the next 40 years. However, with radiotherapy, the local dose to a tissue can be much higher than a fatal total body dose would be. Certain tissues and age groups are more sensitive (e.g. children for all tissues and adolescent girls for breast irradiation). However, over all the risk is difficult to quantify as studies are of necessity observational. I came across a study once comparing second cancers in men who had had prostate radiotherapy vs. prostatectomy, finding a higher incidence of bladder and colorectal cancers in the irradiated group; however, the factors that would tend to make somebody an anaesthetic risk (smoking, obesity…) are also risk factors for these cancers and hadn’t been properly corrected for.

      Generally speaking, radiation-induced solid tumours tend to take about 30 – 40 years to appear after exposure. Reticuloendothelial tumours, however, (lymphomas and leukaemias) occur much sooner, with excess cases peaking at about 10 – 15 years. This probably reflects how long it takes for a cancer to become clinically apparent. It is unlikely that you will ever diagnose a tumour with fewer than 1,000,000,000 cells (which would be about the size of a pea), whereas a tumour burden of 1,000,000,000,000 cells is generally fatal (this amounts to about a kilogram). If you imagine the tumour slowly growing exponentially, then you will see that it only makes itself known during the final quarter of its life (actually much less than that as by the time a cancer has appeared clinically the cells making it up have undergone many mutations, with the effect of making it grow faster and behave more aggressively).

      So I would say that it is possible that the DXT cause your father’s leukaemia, but more likely that it didn’t.

      • Dr Money-Kyrle, thank you for that fascinating response, which I have much enjoyed reading. I appreciate all your contributions here (as a non-medical layman) and I hope you have a book coming out, because, like Professor Ernst, you write with plangent clarity!
        I hope it will not seem patronising if I wish you all the very best with your current health condition, and treatments.

    • My local dentist is excellent “The home of pain-free dentistry” (I told them they had just transferred the pain to the wallet). It is striking how short the exposure time is for modern digital-imaging dental X-Rays compared to the 1970s – and how carefully the staff keep out the way even for those tiny-duration exposures.

      Old 50Kv AC tubes with D-speed wet films had exposure times of a couple of seconds in some cases. For modern 60-70Kv DC tubes and phosphor plate digital systems, the exposure time is a tenth of that. For the operator, you need to be standing 2m away and out of the way of the central ray. The controller for my tube is on the wall at the end of the chair, but many dentists still hide outside the room at the end of long cords. It’s strange how old habits die hard.

      The dosages from modern digital films is miniscule – in the order of one or two microsieverts. By comparison, the exposure from an abdominal film is about 8,000 times that.

  • May I submit for review by your readers a recent publication relating to musculoskeletal radiology. It must be noted that imaging has the highest diagnostic strength of evidence of any other procedure. I must remind you that chiropractic management is based on a clinical diagnosis followed by therapeutic intervention. As such, this manuscript is informative on how chiropractic, in 2020, not comments made by you on 1895 historical events is important and relevant. https://www.radiologycases.com/index.php/radiologycases/article/viewFile/3890/pdf

    • How do chiropractors diagnose the strength of ‘vital energy’ and ‘innate intelligence’, and the extent to which they affect any pathological or physiological process?

      • @RR: having been married to one and lived-the-life for many years I’d say a small part is done by motion-palpation, leg check analysis, heat-readers, posture-checkers and how far-out Atlas is on x-ray…..but overwhelmingly THE most IMPORTANT determinant of how Chiroquackery will enhance the innate-powers is by appeal to the patients’ insurance coverage and/or size of their wallet.

      • It’s all done by inference much the same way a fortune teller “reads” the lines in your palm, an astrologer interprets the implications of different star configurations on your life, or … moving toward an appreciation of the chiropractic fiction, an acupuncturist interprets the surface of your tongue or the strength or weakness of a pulse when making their diagnosis and directIng their treatment.

        Of course, chiropractors have their own set fictional signs from which they infer chiroPRACtic problems that need, according to them, “fixing.” These “signs” of might include “high” shoulders, “functional” short legs, palpated “taut & tender” fibers, head “tilt’” and, related to this discussion, non-pathological interpretations made by the chiropractor of vertebrae which they they believe to be out of place” or not in its optimal position.

        Of course, like the astrological “sky,” the “lifeline” in your palm, or the “coating” on your tongue, none of these arbitrary chiropractic “signs” of trouble has been verified to BE a problem, never mind that chiropractors can do anything to “fix” them.

        Whoops ?

      • They don’t. Its a premise.

  • @faux dr Epstein: “I must remind you…” lol, I love when quacks try to flex their muscles and attempt to admonish the real doctors who have real credentials and true erudition. It’s quite endearing in an embarrassing sort of way. Are you still telling patients that their “abnormal neck curve” is the source of their bad health?

    • Kenny please catch up on your spine orthopedics before you make a comment. A big chapter called sagittal balance that you are missing… Please find it in every spine textbook…

      • @Faux dr Gwiz: “please catch up on spine orthopedics before you make a comment…”. Perhaps a more pertinent admonishment would be “faux doctors: go get a real degree and quit selling entrepreneurial theatrics masquerading as healthcare before you make a comment”. My comments don’t have stealing public funds and entrapping gullible citizens into a faulty paradigm as their motivation. Additionally are you suggesting that anyone who has “caught up with spine orthopedics” will, by compelling-evidence be in agreement with Chiroquackery?? Or YOUR version of Chiroquackery? Ergo if only Professor Ernst would “catch up on spine orthopedics” he’d believe just like you? Sounds like fallacious reasoning…or more accurately Chiroquackery reasoning.

  • Obviously, we should conform to the guidelines, and I believe if you compare US to EU Chiropractors you will find them much more conservative in their approach to the issue.

    However, the over ruling that radiographs have no contribution other than to rule out red flags is nonsense. It is well within the spinal orthopedics acceptable knowledge to measure K line, spino-cranial angle, C7 slope, sacral slope, pelvic tilt, pelvic inclination etc. and make clinical decisions accordingly. You will find that is a common daily practice in every “spine unit”.

    • Only those that practice quackery.
      QED.

      • Wowww could you be more embarrassing???

        When you find the time to get off your high horse please call your local spine surgeon and check with them… You will be surprised to find how steep is the fall from your Ego to your actual Knowledge.

  • @EE
    If you look at recent papers discussing implementation of guidelines and research into clinical practice in health care it is around 17 years which I find surprising. Previously I read it was 10 years.

    I recommend reading Hazel Jenkins papers:
    Current evidence for spinal X-ray use in the chiropractic profession: a narrative review
    Hazel J Jenkins, Aron S Downie, Craig S Moore and Simon D French. Chiropractic & Manual Therapies 2018 26:48. 21 November 2018. Doi: 10.1186/s12998-018-0217-8
    Imaging for low back pain: is clinical use consistent with guidelines? A systematic review and meta-analysis.
    Jenkins HJ, Downie AS, Maher CG, Moloney NA, Magnussen JS, Hancock MJ. Spine J. 2018 May 3. pii: S1529-9430(18)30203-1. doi: 10.1016/j.spinee.2018.05.004.
    Awareness of radiographic guidelines for low back pain: a survey of Australian chiropractors.
    Jenkins HJ. Chiropr Man Therap. 2016 Oct 5;24:39.
    Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain.
    Jenkins HJ, Moloney NA, French SD, Maher CG, Dear BF, Magnussen JS, Hancock MJ. BMC Health Serv Res. 2018 Sep 24;18(1):734. doi: 10.1186/s12913-018-3526-7.

    Additionally:
    Essential key messages about diagnosis, imaging, and self-care for people with low back pain: a modified Delphi study of consumer and expert opinions.
    French SD, Nielsen M, Hall L, Nicolson PJ, van Tulder M, Bennell KL, Hinman RS, Maher CG, Jull G, Hodges PW. Pain. 2019 Jul 23. doi: 10.1097/j.pain.0000000000001663.

    This is one of my favorites:
    Overuse, Overdose, Overdiagnosis… Overreaction?
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097773/?tool=pmcentrez

    This paper by Kenneth Young does have a great title and is also a good read:
    Gimme that old time religion: the influence of the healthcare belief system of chiropractic’s early leaders on the development of x-ray imaging in the profession
    http://www.chiromt.com/content/22/1/36

  • Chiropractors using ionizing radiation to make any of their self-referencing chiropractic diagnoses adds injury to the first chiropractic insult that the chiropractic spine holds the secrets of health and disease.

  • Nonsense! An x-ray is wonderful for a bad back. Just ask all those who get better after having an x-ray!

    😀

    • @Björn Geir
      Actually if you look at the research the prognosis for back pain patients worsens as soon as they get imaging especially advanced imaging like MRI.

  • For the chiropractors who post here, what specific chiropractic problems do chiropractors SEE on the X-RAYs they take that have actually been demonstrated to BE a problem (in the first place) and then, importantly (in the second place, if you will), can any of these “problems” be fixed WITH chiropractic treatment once they’re spotted on the X-RAY? Can any of you name three of these “problems” for which taking an x-ray was needed for diagnosis and the specific chiropractic treatment that has been demonstrated to “fix” the diagnosed chiropractic problem?

    Anyone?

    ~TEO.

    • @John Badanes
      More importantly, you should be asking what are the criteria for referring for xrays using current guidelines and best practice?
      Hint: It should not be a fishing expedition for a medical diagnosis by doctors or mythical subluxations/marketing by chiropractors or to satisfy patient demand/expectation or to drum up business for medical radiologists who gave you a nice big Christmas hamper, pens, post it notes, lunch/”lecture” at a very expensive restaurant.
      Current research:
      Current evidence for spinal X-ray use in the chiropractic profession: a narrative review.
      https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0217-8

      • “The results suggest a strong adherence to radiography guidelines for patients with a new episode of low back pain who presented to chiropractic teaching clinics.”

        Spine: October 15, 2007 – Volume 32 – Issue 22 – p 2509-2514

        • The overall radiograph utilization rate was 8%,

          J Chiropr Med. 2012 Dec; 11(4): 242–248

          • Although some evidence suggests that patients with
            LBP in the ED are appropriately imaged based on the American College of Radiology appropriateness criteria,20 other studies have reported that 30% of patients
            in which imaging for LBP was not indicated received
            imaging,19 suggesting substantial practice variation
            across EDs.

            ACADEMIC EMERGENCY MEDICINE • June 2018, Vol. 25, No. 6

    • First of all there is no such thing as a “chiropractic problem”.

      The diagnosis the patient gets from me is the same as he would get from the spine surgeons i work with. For that you sometimes need imaging.

      The choice of techniques and whether or not the patient is suitable for treatments is according to the diagnosis.

      • “First of all there is no such thing as a “chiropractic problem”.”

        Nailed it.

        • Chiropractic: the profession where denial is a precondition of practice?

          • Perhaps for some.

          • Carpet bombing critics where the denial of the collateral damage they do to researchers, reformers and academics with sweeping statements and generalizations is a precondition of practice. 😉

            P.S. What is in the red box at the top of this page?
            “Please remember: if you make a claim in a comment, support it with evidence.”
            BTW citing blogs is NOT evidence.

          • For some it is too difficult to type ‘some’.

  • I asked: For the chiropractors who post here, what specific chiropractic problems do chiropractors SEE on the X-RAYs they take that have actually been demonstrated to BE a problem (in the first place) and then, importantly (in the second place, if you will), can any of these “problems” be fixed WITH chiropractic treatment once they’re spotted on the X-RAY? Can any of you name three of these “problems” for which taking an x-ray was needed for diagnosis and the specific chiropractic treatment that has been demonstrated to “fix” the diagnosed chiropractic problem?

    Anyone?

    At this point after a week, I’m guessing that “anyone” who WAS going to answer my rather straightforward question has submitted their best effort and so, for the moment, we’ll view these contributions from the chiropractic peanut gallery as their “final answer.” Not surprisingly, no one was able to name a Chiropractic Problem (that has been demonstrated to BE a problem, in the first place) that a chiropractor SEES on an x-ray which has been demonstrated to be fixed WITH chiropractic treatment once spotted on a film … at least, not one thing according to chiropractors here.

    Best squirmy effort goes to Dr Guy Almog who attempts to sweep the ENTIRE chiropractic profession under the carpet by simply asserting there’s no such thing as a “chiropractic problem.” That, of course, begs the question as to what it is that chiropractors have been diagnosing and treating all these years. Just what ARE they all “Adjusting” every which way but loose? Misalignments and other Subluxations? Vertebrae “off a level base?” Laterality? Sacral Base posterior? Spinal “Imbalance?” Functional leg length differences? Posterior-Inferior ilea? Atlas rotation? Bad posture?

    Hello? 🙂

    Aren’t these SOME examples of clinical concerns that many chiropractors assert ARE a problem and, to their satisfaction (apparently) have been demonstrated to be fixed BY chiropractors? Of course they are. And, most every one of these CHIROPRACTIC diagnoses listed can be “SEEN” on X-ray. So, to repeat, have these chiropractic “problems” been demonstrated to BE a problem and have they been demonstrated to be “fixed” by chiropractic treatment?

    Leaving, for the moment, this wide open fly in the profession’s pants, if Dr Almog insists that HE only diagnoses and treats medical things, then he should, at least, still name three of those medical things that as a chiropractor, HE would see on an x-ray that has also been demonstrated to be consistently well managed with “chiropractic” … what … “Adjustments,” Dr Almog?

    Honorable mention should go to “Critical Chiro” who posts a paper that concludes there’s no good reason for chiropractors to take X-ray … except, perhaps, to determine who is NOT a Chiropractic Patient. And that’s really not enough to argue the use of X-ray by chiropractors, I’m afraid, as the paper argues. Not saying that if case history and exam warrant, imaging might not be indicated. It just wouldn’t be for anything a chiropractor would diagnose and treat. Obviously.

    I suppose an honorable mention, but for ineptitude, should go to “DC,” who always manages to remind me why it is that chiropractors deserve their well-earned black eye whenever they step up to the plate to hit a homer for the Chiropractic Team.

    “Nailed it!” DC? 🙂

    ~TEO.

  • Hi
    Sorry for the delay, since you mentioned me in person I will find time to get back to you tomorrow morning.

  • OK… there goes my coffee break 🙂
    I read your “question” and I am sorry but you are making a big salad here.

    All the terms you have mentioned are all to do with the specifics of “facet sprain strain injury” or “chronic facet OA”. These are two very common diagnosis. Within these entities chiropractors have attempted to describe mechanical characteristics (like PI illium etc.). Sure we can argue about it but in any case these are not the prime diagnosis. Therefor i repeat what i have said earlier… there is no such thing as a Chiropractic problem.

    Now for the need for Xrays.
    A 63 YOS patient with “simple low back pain” with no apparent contraindication for SMT but on xray you see degenerative spondylolisthesis G2 at L4 around the same level of pain… is he still suitable for manipulation / mobilization at that level?

    A 47 YOA patient suffers from chronic simple LBP and on standing EOS xray you see lumbar kyphosis and loss of sagittal balance…will that change your treatment and exercise routine?

    A 32 YOA young mother with OCI at the same side of pain… will you not consider that as a possible source of pain and treat her SIJ?

    I understand you truly believe you understand what chiropractors do but you don’t.

    Chiropractors should conform to regulation and guidelines like everyone else. However, the trend now by physio and GP’s to dismiss the need for radiology is nonsense!!! The fact one doesn’t know how to read imaging and relate that to a sound physical examination does not dismiss the need for radiology just means one should go and study.

    • Dr Almog

      I suspect John knows there is only one “specific chiropractic problem” and no, that can’t be seen on an x ray.

      Thus by stating the criteria as a “specific chiropractic problem” he limited the inclusion to that which he knows is beyond seeing on x rays.

      Thus, he set the request up so only he can “win”. Childish IMO but some feel the need to “win” rather than have an intelligent discussion.

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