This is a question we hear almost daily in our office from existing and new patients. Most current clinical guidelines recommend (and this is my clinical opinion) that the majority of back and neck pain patients do not require x-rays in order to help them with a complaint.
Under the guidelines of the College of Chiropractors of BC (CCBC), chiropractors are permitted to take and interpret x-ray imaging for patients. A big component of that training is also dedicated towards deciding if and when a patient requires x-rays.
The guidelines for taking x-rays from the CCBC are very strict and are as follows:
A chiropractor may
(a) apply X-rays to a patient, or
(b) issue an authorization or instruction for another person to apply X-rays to a patient, including X-rays for the purpose of computerized axial tomography,
Only if the application of X-rays is indicated by a patient history or physical examination that identifies serious pathology or clinical reasons to suspect serious pathology.
Routine or repeat X-rays used as a regular protocol during the evaluation and diagnosis of patients are not clinically justified. This includes:
(a) X-rays to screen for spinal anomalies or serious pathology in the absence of any clinical indication,
(b) X-rays to diagnose or re-assess spinal conditions in the absence of any clinical indication, and
(c) X-rays to conduct biomechanical analysis or listings to identify spinal dysfunction, whether called subluxation, fixation or by any other term.
The majority of neck, back and extremity complaints don’t required imaging to diagnose and the X-rays should never be used for the main purpose of patient education. In fact patients who receive imaging for injuries have a tendency to take longer to recover and the costs associated with it are higher.
Two of the best resources that help explain why imaging is not indicated for most injuries are linked here:
https://choosingwiselycanada.org/pamphlet/imaging-tests-for-lower-back-pain/
At Momentum Health, if we feel a patient requires imaging of any kind, we refer them to their medical doctor. We do this for 2 reasons, the medical doctor is now involved with the process and the patient has another professional helping with a diagnosis. Our patients are referred to the imaging clinics in Kelowna and the x-rays are paid for with your medical services plan.
Our patient intake process is not what you may have experienced at other clinics. We pride ourselves on completing a thorough history of the main complaint and also investigate previous medical history. Our assessments are movement based, which allows to evaluate your biomechanics and function much more accurately than what a static X-ray could.
Marc Nimchuk
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