This is a more complicated question than some believe. X-rays and MRIs are useful diagnostics which can reveal much about the reason you’re coming to see me – pain.
X-rays are dedicated to revealing anomalies in the skeletal system, while MRIs provide information about the state of soft tissue and its role in pain.
So, how necessary is it to get an X-ray or MRI when visiting me? That depends! Let’s unpack the question.
When X-rays play a role
X-rays can provide me with crucial information about your condition, in certain cases. Sometimes, they’re used as a protective measure by chiropractors, in the event there’s the likelihood of a tumor or fracture. This practice benefits both chiropractor and patient.
But while it’s true that X-rays play a role in the determination of the root cause of some cases of back pain, they’re not necessary for most people who come to me to resolve the issue.
A retrospective study examined 350 S-rays and revealed that only 15% of them were able to clarify skeletal pathologies which required a different approach in treatment. The study concluded that most S-rays were unnecessary and exposed patients to radiation for no good reason.
That said, when I detect a probable cause for a patient’s discomfort that indicates an X-ray would be useful, I will commission the diagnostic. I’ll also send the patient for X-rays when several weeks of work render no results. Clinician discernment is the determining factor and it’s important that chiropractors not abuse that status.
X-rays are indicated when there’s been trauma which may have resulted in damage to the skeletal system, or if a tumor or infection is suspected.
When MRIs play a role
MRIs are a costly diagnostic and while sometimes necessary, they don’t always change the way the pain problem presenting is approached.
When MRIs are most useful is in the event of serious trauma, like injury to the spinal cord, itself. The American College of Radiation’s guidelines state that MRIs to the neck are not generally indicated. For the lower back, the ACR deems MRIs appropriate, but at the chiropractor’s discretion.
For non-specific pain in the lower back, the ACR’s guidelines suggest that waiting 6 weeks to opt for advanced imaging like this is advisable.
But all the same, 2/3rds of all MRIs are conducted within the first month of treatment, in direct contravention of the guidelines. This adds to patient expense unnecessarily.
As a chiropractor, my hands are the first line of diagnosis. Because I’ve been highly-trained to detect anomalies via palpation, I’m able to determine an appropriate therapeutic response in many cases, without the help of imaging. But when my own efforts lead to believe there’s an underlying problem which needs to be confirmed with diagnostics, I’ll order an X-ray or MRI.
Likewise, if patients aren’t responding to chiropractic care, I’ll commission the appropriate diagnostic. Diagnostic testing is not intended to be used frivolously or inappropriately.
If you’re experiencing pain, book a consultation with me.