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Posted on 03-03-2014

X-rays in a Chiropractic Office?

As a Chiropractor with a busy practice in Baltimore I see a lot of patients. Mainly they have headaches, neck pain, and back pain or some combination of the above. Most are referred to me by friends, family, doctors, previous patients, etc. Regardless of how patients find me one of the most common questions I get asked is "do I need an x-ray?". Like most questions in clinical practice, there is no simple yes or no, but rather a series of guidelines that can be followed which, when combined with clinical intuition, can lead to an answer.

The first thing you should think about is why a patient might need an x-ray. Simply put, x-rays look at bones. They give me a picture at a moment in time as to the underlying spinal structures so that I can determine if it is safe to perform physical therapy with or without chiropractic manipulation. Essentially, I am looking to rule out contraindications to chiropractic care and physical therapy. If there is any indication of fracture, dislocation, cancer, infection, or instability found on x-ray then I know how best to proceed with care. I will not take an x-ray simply because you "want to see what you look like." That is irresponsible care.

The good news is that generally speaking, most new patients do not require x-rays. If a patient has an acute case of non-radiating, reproduceable spinal pain then chances are a short course of conservative chiropractic therapy and physical therapy modalities will help and the patient will respond quickly. I tell most patients that if the therapy I am going to provide will help they should expect to see some form of improvement (be it better range of motion, decreased pain frequency and/or severity, less radiation of pain, etc) within 2-4 weeks. If at that point they are not improving or if they are getting worse, we can either take an x-ray at that point or consider referral for other advanced imaging (MRI, CT, ultrasound, etc) at that time. By some accounts 80-90 percent of new chiropractic patients with neck and back pain fall into that category and do not require an x-ray on their first visit.

The last 10-20 percent of patients typically do require x-rays on their first visit. These are patients who have a history of metabolic diseases (think decreased bone density), history of spinal fractures, history of spinal surgery, new onset of radiation of pain past the elbows (upper extremity) or past the knees (lower extremity), pain that wakes you up at night, new onset of pain over age 50, and acute trauma (think motor vehicle collisions, whiplash injuries, auto accidents, slip and fall injuries, worker's compensation injury, etc).

Fortunately for me and my patients I purchased and installed a new digital x-ray developer. This allows me to take any necessary x-rays and have them developed and read in about 60 seconds. Patients that require x-rays do not need to reschedule or be referred off-site prior to getting the care that they need. I will always give patients a copy of their x-rays on a CD so that they can archive them for their records and/or bring them to any other medical provider should they need to do so. I transmit all of my x-rays digitally to a teleradiology group to make sure that board certified radiologists confirm my findings and protect the health of any new patient. A second set of eyes is always better than just one.

If you are not sure that you require an x-ray on your first visit we can discuss the pros and cons given your specific circumstance and make an appropriate choice at that time. If you, or anyone you know requires chiropractic care that may include the need for an x-ray, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

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