Imaging (x-rays, MRI, CT and Ultrasound)

Imaging (x-rays, MRI, CT and Ultrasound)

Learning to understand imaging is an integral part of the education of a Doctor of Chiropractic.  The need for imaging should be weighed appropriately as radiation exposure and expense can be a concern.  

Current research has demonstrated that there may be unforeseen concerns with "early imaging".  One study showed that early imaging has been associated with increased medical cost, increased incidence of surgery, worse/more frequent disability and worse health outcomes that were unrelated to symptoms severity. 

 Another study that performed imaging on asymptomatic veterans initially and then again 3 years later and included a health survey every 4 months found no association between new back pain over the 3 years with regards to findings of disc or facet degeneration (arthritic changes). Central spinal stenosis and nerve impingement had the highest hazard ratio for back pain among baseline imaging findings but were not significant predictors of future back pain; interestingly, reported depression was the most significant indicator for future back pain.

There are health indications where imaging may be necessary, sometimes urgently.  Prompt imaging  is appropriately recommended when there is suspected fracture, suspicion of an underlying pathology and/or significant progressive neurological issues, especially when neurological symptoms are associated with the central nervous system (brain and spinal cord), as opposed to the peripheral nervous system (rest of the body).

Some chiropractors like to x-ray most patients; this boosts their income and gives the patient a reason to come back for at least one additional appointment.  Imaging becomes part of their business model, as opposed to something that is dictated by best standard of care.

The current standard of care from most schools is that, if there are not direct indications for necessary imaging, a trial of care of up to a month is appropriate; after the trial of care, imaging may follow if no health gains are achieved or if symptoms are progressive.  

Neck pain with peripheral nerve symptoms (pain, numbness or tingling) in an arm or arms and/or low back pain with peripheral nerve symptoms in a leg or legs are frequent reasons that imaging is ordered by doctors suspecting disc herniation.  Research has shown that patients with disc herniation, typically, show a positive response to chiropractic care within a month and 75%-91% (depending on acute or chronic symptoms and location of herniation) of patients showing significant improvement within 3 months by chiropractic care.  Conservative care, such as chiropractic, is now the first form of care recommended by the American Medical Association for back pain with or without peripheral nerve symptoms due to the cost effectiveness and positive outcomes from chiropractic care.  Positive outcomes are the most common results without the expense, hazards and potential for iatrogenic depression associated with unnecessary imaging.

At Gallatin Valley Chiropractic, our doctors will provide patients with a thorough physical exam prior to care.  If imaging is necessary, the patient will be referred for necessary imaging and if a patient has a condition that is not appropriately treated by chiropractic, our doctors will refer that patient to the appropriate health care provider.

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