Answers to Questions about Chiropractic:
When Should Chiropractors Take X-rays?

Samuel Homola, D.C.

QuestionWhat are the guidelines for approrpriate use of x-ray examinations by chiropractors?

Answer

Because of the cumulative and harmful effects of ionizing radiation, x-rays should be done only when necessary and never as a routine office procedure. Because of the chiropractic theory that "vertebral subluxation" or misalignment is the cause of many health problems, there is a tendency among chiropractors to overuse x-ray to for hunt for subluxations and to promote unecessary treatment. So there is reason for caution when undergoing x-ray examination performed by chiropractors.

X-rays of the spine should be made only when there are spine-related symptoms. Use of x-ray to search for "vertebral subluxations" when treating a patient for a health problem is harmful to health as well as a waste of time and money. Full-spine x-rays, in which the entire spine is seen on one sheet of film, should never be done, because they require a large dose of radiation and have little or no diagnostic value.

When x-rays are indicated, they should cover only the area in question. It is unnecessary to x-ray the neck, for example, when there is low back pain. Some chiropractors feel that misalignment of neck vertebrae causes health problems as well as back problems. So they x-ray the neck of every patient they see. I would avoid such chiropractors.

Except in special cases, when there are "red flags" (serious warning signs) indicating possible fracture, bone disease, disc herniation, or some other serious problem, x-ray examination is rarely necessary during the first month of back or neck pain.

Low-back pain is the most common reason for x-raying the spine. Unless there has been an injury serious enough to tear ligaments or cause a fracture, initial x-rays should be limited to two views—one from the front and one from the side. Oblique views made from different angles greatly increase radiation exposure and are rarely needed. Chiropractors who routinely obtain a series of x-rays for every new patient may be motivated more by a financial incentive than by concern for the patient's welfare. When the x-ray series includes every portion of the spine, from the neck to the low back, and there is pain in only one area of the spine, the patient is being subjected to unnecessary radiation.

Once a set of x-rays has been made, it's rarely necessary to repeat the exam within the next few years unless there is persistent neck or back pain of unknown origin, progressive bone disease, or a new injury. If you change doctors, you should always take along your records and x-ray films in order to avoid unnecessary repetition.

I would stay away from any chiropractor who offers "free x-rays" or insists that every new patient be x-rayed. Chiropractors who offer free x-rays will hook patients by finding "subluxations" undetected by medical practitioners and then periodically x-ray their patients to monitor "subluxation correction."

In the vast majority of cases, simple first-time neck or back pain will resolve with time and simple treatment. In the absence of red flags, when symptoms have not been present for more than a few weeks and there has not been a serious injury, x-ray examination will rarely reveal the cause of the pain, which must be evaluated by physical examination, time, and observation. If symptoms become severe or persist for longer than a month, an x-ray exam might be indicated.

Remember that x-rays made in a chiropractor's office are not likely to equal the quality of those made in a department of radiology. If an x-ray examination is needed, it's usually best to have the films done and interpreted by a medical radiologist and then have them and the report made available to your chiropractor.

_________________

Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This page was posted on June 5, 2002.