First, it’s important to know what X-Rays are good at visualizing. They are relatively good at visualizing fractures and dislocations resulting from trauma. They also are good at visualizing bony changes that result from chronic joint diseases/various arthritic conditions. They can also visualize “bone spurs,” intervertebral disc spacing, and some anatomical abnormalities like scoliosis.
X-Rays are not good at SCREENING for serious underlying disease (such as cancer and infection). This is especially true for early stage disease when most patients are asymptomatic. Anywhere from 30-50% of bone must be gone in a certain area before it can be seen with X-Ray technology. By this point, the patient would very likely be having other health issues other than just neck/back pain which would warrant MRI investigation, NOT X-Ray. MRIs combined with blood tests are very good at diagnosing serious underlying disease (cancer and infection). The downside to MRI being it’s high cost and more limited availability.
So for the things that X-Ray is able to visualize reliably…. Does seeing those things automatically change patient management? Outside of traumatic fractures & dislocations or special types of arthritis the answer is NO! For example, the diagnosis of disc degeneration (AKA osteoarthritis) is a common finding on X-Rays that is then explained to the patient to be the cause of their neck/back pain. Management/treatment of that patient remains the same with or without the X-Ray, however. So what was the point of the X-Ray to begin with?
Research has also shown that around 37% of 20 year olds and 96% of 80 year olds have disc degeneration on X-Ray. And the kicker…. The vast majority of those individuals have NO SYMPTOMS whatsoever! This fact perfectly demonstrates how unwarranted X-Ray imaging can actually be detrimental to the patient rather than helpful. Imagine going through life with the diagnosis of “disc degeneration?” Sounds scary, right? Sounds like you could make it worse if you’re not careful, right? WRONG!
But if chiropractors aren't taking X-Rays of their patients then how do they know where to start? The answer is taking a detailed medical history where the patient tells THEIR STORY. This is then followed up with a detailed physical examination which provides the clinician with information about the behavior of the patient’s pain/injury.
But how can they be sure that their patient doesn’t have underlying disease presenting as neck/back pain? Again it comes back to the history and exam. Throughout the history and exam a trained clinician will be on the lookout for what we call “RED FLAGS.” These red flag signs are indications that the patient’s pain is caused by something other than uncomplicated musculoskeletal sources. These red flag signs are actually quite reliable in diagnosing serious disease too!
In summary, YOU are WAY MORE than what an X-Ray may or may not show. At SCWC we treat the patient, not the image!