Three commonly asked questions popped into my mind:
- Does every chiropractic patient need an x-ray?
- Does anyone really need an x-ray?
- Are x-rays dangerous?
1. Does every chiropractic patient need an x-ray? In a word, no.
Many years ago, some chiropractors believed that to see which spinal joints were "out of alignment" an x-ray was necessary. However, it has since been proven (again, years ago) that the "out of alignment" theory is somewhat flawed. If you really had a true "spinal misalignment" that was visible on x-ray, you would probably need something a lot more invasive than a chiropractic treatment to sort it out for you!
These days it's more accurate to say that the spinal joints are "stiff or restricted" in their movements, rather than "out of alignment". In other words, the problem is with the amount of movement in the joints, not their position. To find out which joints are stiff and restricted we simply have to ask you to move in certain positions and use our hands to check the movement manually. Stiffness and restriction cannot be assessed using a static picture (x-ray/MRI). As most chiropractic patients' pain is caused by this sort of stiffness and restriction, any form of imaging is simply not necessary, especially when you consider the radiation dosage associated with x-rays.
2. Does anyone need an x-ray? Sometimes, yes.
The only patients that need an image taken are those whose case history suggests cancer, a bone or joint infection, a fracture (broken bone) or full thickness cartilage/ligament/tendon/muscle tear from trauma, an inflammatory bone or joint disorder or osteoarthritis in the hip, knee or shoulder (but not the spine). If this was the case an MRI scan would be a far better bet in most cases as all the soft tissues (cartilage, ligaments, tendons, muscles etc) are seen on the scan. On an x-ray, only bones are visible which is fine for a suspected fracture or hip, knee and shoulder osteoarthritis but not a great deal else.
3. Are x-rays dangerous? No but they do give you a dose of radiation which is not particularly healthy. Being exposed to X-rays carries a theoretical risk of triggering cancer at a later date, as does exposure to background radiation.
Everyone is exposed to sources of natural radiation throughout their life. Natural radiation is sometimes known as background radiation. Sources of background radiation include:
- Radon – a naturally occurring radioactive gas found in low levels in the atmosphere.
- Cosmic rays – a type of radiation that originates from space (from the sun and stars).
- The earth – soil and rocks contain various radioactive materials that have been present since the earth was formed; these contribute to our exposure, as do building materials made from soil, rocks and stones.
- Food and water – for example, nuts, bananas, red meat and potatoes all contain tiny traces of radiation.
One spinal x-ray is the equivalent of a few months' to a year's worth of background radiation and has a 1 in 10,000-100,000 chance of causing cancer. When x-rays are taken, two or three are usually taken to make sure everything in the area is seen. So, those figures need to multiplied or divided accordingly.
So in summary, x-rays aren't usually required for back or neck pain, are occasionally useful for suspected fractures or osteoarthritis of the hip, knee or shoulder (not the spine) and aren't particularly good for you. I would say in the last twelve months, I have sent five to ten people for x-rays.
My personal opinion is that anyone offering an "x-rays for everyone" policy perhaps needs to update their understanding of anatomy and physiology. There are only a handful of reasons why an x-ray should be considered and back and neck pain are not among them.
Until next time...