X-Rays and MRI’s…The NOT so very accurate or effective way to diagnose someone in pain.

A common practice in many chiropractic offices is the routine use of x-ray and MRI to “diagnose” musculoskeletal issues and to also investigate postural asymmetries and degrees of degeneration in a patient’s spine. 

While there is a time and place for imaging, it should NOT be the first line of defense unless warranted….Why is this you ask? 

  • IMAGING IS USEFUL FOR RULING-OUT RED FLAGS such as tumors, cysts and bone fractures. What imaging can’t do is accurately identify the origin of your pain. 

Essentially many people (especially those over the age of 30) have some level of disc degeneration, but up to 70% of these people are pain free. So patients can have many negative radiological findings and yet have absolutely zero pain or dysfunction! 

On the other hand people that have chronic low back and neck pain can have absolutely pristine MRI’s with zero signs of damage or injury. 

Plainly said, you can have disc degeneration confirmed by imaging with zero pain, and you can have immense pain with zero imaging findings. In the end, imaging is not a reliable indicator of where your pain is coming from and the exact reason you are experiencing it. 

  • If someone is receiving care and their symptoms are NOT progressing how they should be or they are getting worse, an image may be warranted to further investigate and rule in or out something that is beyond conservative care, however imaging should never be the first course of action. 

Patient outcomes actually get WORSE when they receive an MRI early in their history of low back or neck pain. How does this happen? Let’s say you have some low back pain and you go to your PCP. They often prescribe an anti-inflammatory and an MRI. The findings of the MRI show levels of disc bulging and degeneration at L4-L5. This patient now feels that the bulge is the sole reason for their pain, they start to pathologize and  catastrophize themselves thinking that the only way to get out of pain is to FIX the disc issue. They are then more likely to avoid healthy daily movement out of fear, avoid exercise and to consider an unnecessary surgery. Now in this example a run of the mill case of non-specific low back pain gets escalated to a surgical issue and because of the long term ramifications of surgery, this should only be considered as a last resort.

What about using X-rays to look at posture?..Unfortunately this is a very common procedure in many traditional chiropractic offices. They take an x-ray of the new patient, the report will show something like a loss of cervical curve, scoliosis and an elevated hip. Once again after receiving these disturbing findings the patients are often scared that their posture or structural abnormalities (found on the doctors x-ray reports) are the reason for their pain. 

After fear is placed upon the patient they are then pressured into a long drawn-out treatment plan with the chiropractor receiving regular adjustments 1-3 times a week for up to 6  months that will ideally “correct your posture and spinal alignment”.  But this is a FARCE, first off an x-ray is a still-photo of a dynamic mobile system. You do not exist in a movement vacuum, and thus potential postural findings seen on image do not give the full clinical picture. We are all born beautifully asymmetrical (uneven) and such asymmetries do not need to be corrected for you to get out of pain. You would be surprised how many chiropractors tell patients their chronic low back pain is due to one of their legs being 2-3 mm shorter than the other. I have yet to meet a patient whose legs are the same length and that has nothing to do with low back pain.

Unfortunately healthcare is a business in this country and the patient is the commodity. 30 plus visits in a treatment plan with continued care every month pays a LOT more than 8 visits with rapid symptom change and the doctor educating the patient in self-treatment and prevention. Until the entire system changes, it’s important to find good, ethical, caring providers who do NOT rely on scare-tactics and non evidenced-based care such as presenting patients with  x-ray findings to get patients “signed up” for their care. 

Key points from this post:

  • Imaging is often used too early in care and has negative impacts on overall patient outcomes
  • People can have imaging findings of disc bulges and degeneration and be completely pain free
  • People with pain can have completely clean MRI’s and X-ray reports yet still have severe pain
  • Lastly, routine use of imaging to look at posture asymmetries is not shown to have clinical value as those asymmetries often have very little do with ones pain at all 

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