I have back pain - do I need a scan? (Part II)


This is a follow on post so we would recommend reading Part I first (click HERE to read Part I)

It has come to our attention that many Chiropractors are still commonly using X-rays as part of their routine lower back pain diagnosis procedure. Looking through current research it is difficult to determine how frequently X-rays are used by Chiropractors in the UK. However a study in Australia of 274 Chiropractors estimated that 68% of these would take an X-ray where an X-ray is not indicated. This is a worrying figure considering the unwarranted radiation exposure to the patients. (see Part I for more details)

An X-ray is only indicated if a tumour or fracture is suspected and this is documented in many Chiropractic guidelines. However, many Chiropractors are still using X-rays to determine if any spinal ‘subluxation’ has occurred. The word "subluxation" means partial dislocation of a joint. The contentious issue here is that there is simply no clinical evidence to suggest spinal subluxation either (1) exist in any clinical meaningful sense or (2) has any clinical relevance to low back pain.

In fact, the limited clinical evidence shows that spinal subluxation, if it at all exists, is very rarely clinically relevant as a cause of pain; however this is a frequent Chiropractic diagnosis based from findings on an X-ray. The only problem with this is (as mentioned in part 1) that on imaging for the back a visible abnormality may not be the cause for the back pain. As we all have anatomical differences and for the majority these do not cause pain.

So our final thought is, if you have back pain and are offered a scan, question the health care professionals. ‘Why do I need one and what are you looking for?’

As a general rule in PhysioQinetics, we only refer for plain x-ray or MRI scan if we have sufficient clinical suspicion of an anatomical pathology and if we are considering referral to specialist orthopaedic surgeons for surgical intervention.

With thanks
• Why do Chiropractors order so many Xrays? Published in 2010
• Chiropractic diagnostic imaging from the Chiropractic board of Australia
• Management of people with acute low-back pain: a survey of Australian Chiropractors published in Chiropractic and Manual Therapies.