Are x-rays absolutely necessary before my chiropractic adjustment?
I get a lot of phone calls and questions about the necessity of x-rays before chiropractic treatment. My best answer is …”not necessarily.”
The taking of x-rays before a chiropractic adjustment is not a requirement and is sometimes contraindicated or best not to do.
There are reasons to perform the x-rays and reasons not to perform x-rays. Chiropractors opinions vary on this topic. Some chiropractors take x-rays on every patient as a general policy. This thought is that x-rays will aid in ruling out pathology such as tumors or bone fractures. Some chiropractors use the x-rays to determine where to adjust the spine. I feel that x-rays are not necessarily indicated in all cases or in all patients. I read in the publication Spine-Health that in a review of 350 x-rays only 15% revealed anything that altered treatment recommendations. In my clinical experience the percentage is really much lower than 15%.
Some important reasons to definitely order x-rays include:
1)Trauma – Trauma including a fall, motor vehicle accident or significant pain after heavy lifting are reasons that indicate the necessity of x-rays before a chiropractic adjustment.
2)Age – If a patient requests or requires manual chiropractic adjustments over age 65 x-rays are indicated. A this age, especially in small framed females, osteoporosis is a concern. Manual adjustments in a patient with osteoporosis can be at higher risk for bone fracture.
Some factors indicating possible necessity for x-rays prior to a chiropractic adjustment include:
1)Sudden onset high level pain – If a patients tells me that their neck or back pain is at a high level with no obvious cause x-rays become a recommendation prior to chiropractic adjustment. A sudden high level of pain without cause is a definite referral to the patient’s primary care physician for evaluation and co-management. A gentle instrument aided adjustment may be performed as co-management. This varies case by case.
2)Scoliosis – If I can observe with palpation that a patient may have a curvature of the spine it may be indicated to get a spinal x-ray. It may not be required prior to the chiropractic adjustment but will likely be ordered by the chiropractor on a case by case basis.
3)Lingering pain – If a patient’s mild to moderate pain does not remit within 1-2 weeks I commonly order spinal x-rays. Uncomplicated neck or back pain will typically decrease significantly within 1-2 weeks of seeking chiropractic treatment. If pain levels remain constant it becomes important to order x-rays or to refer out to a medical physician for evaluation and co-management.
4)Previous history of malignancy – Again, x-rays are not required prior to chiropractic treatment in this case. Persistent mild to moderate pain over the course of one to two weeks is and indicator for x-rays and possible medical referral.
X-rays are not indicated in these cases:
1)Age – Patients below age 65 with mild back pain or discomfort with no history of trauma or heavy lifting do not necessarily need x-rays unless the pain gets worse or does not remit in 1-2 weeks.
Patients age 25 or younger- It is rare that x-rays are indicated for a patient below the age of 25 without the history of trauma.
2)Pregnancy – A pregnant woman should absolutely not get x-rays unless advised by her medical doctor that is aware of the pregnancy.
Most visits to the chiropractor are within the category that should not require x-rays. It is absolutely critical that x-rays are taken in some situations though. Ask your chiropractor what they think and what their typical philosophy is regarding x-rays and chiropractic.
Please call Dr. Carlton at 941-301-8323 with any questions about x-rays and chiropractic. You can also email Dr. Carlton at DoctorCarltonCares@gmail.com.
