When it comes to diagnosing the cause of someone’s pain, it makes sense to take x-rays, right? With an x-ray, you can see all the “bad” things that are happening in your spine, and know that THAT is what is causing your pain. I take a different approach in my practice, and in this blog, I’ll give you some more information so that you can have the necessary information BEFORE going to see the doctor.
Do X-rays show WHY someone is having pain?
The answer to this question depends on why, exactly, the patient is coming to see the doctor. For most people who have back pain or neck pain, an x-ray isn’t going to really tell you anything about WHY the pain is there. We have seen time and again that diagnostic imaging like x-rays and MRIs don’t actually correlate with whether the person has pain. Multiple studies have found similar “degenerative” finding in pain-free populations vs. people who have back pain. Could some of these processes be a contributing factor? It is possible, but overall, if imaging is done before a trial of care for back pain, then the imaging doesn’t change the planned course of care. However, if someone has had a failed course of care (4-6 weeks), meaning there has been no change or symptoms have gotten worse, then sometimes imaging can be helpful.
Will getting imaging improve my prognosis?
In most cases, the answer is no. In fact, when people get imaging early on in their care without the medical necessity, it can actually INCREASE their risks of becoming permanently disabled. This is because people see the “degeneration”, are told that they can’t reverse it, are told it is the reason for their pain, and that it will only continue to get worse for them. If you have “degenerative disc disease”, you can’t reverse it, and it is the cause of your pain, what other conclusion can you come to other than there is no hope for getting better?
It is true that you wont reverse degeneration, but as I mentioned before, it isn’t likely the “cause” of your pain. In most cases, pain is a result of muscular imbalance and activation issues, compensatory movements, and sedentary lifestyle. By addressing these issues, symptoms can improve greatly. Not only that, but since the way to keep joints healthy is through full range-of-motion movement, it can be argued that we may even minimize the rate of degeneration over time by adopting beneficial lifestyle changes.
When should we be getting imaging?
If you have had a traumatic injury, if there is a concern for a major pathology like cancer, a concern for a structural pathology like ankylosing spondylitis (where the ligaments along the spine ossify/“turn to bone”) or scoliosis, or if there has been a failed trial of care where your symptoms showed no improvement or got worse, then there is a good reason to get an image of whats going on beneath the surface. In these situations, as a chiropractor, I will have more information to be able to plan care according to what will be safe and effective for a particular patient. In these situations, the course of care may be changed from what the more common treatments are.
Are there any health concerns with Xray imaging?
As a rule, we want to minimize exposure to x-rays due to the fact that they are harmful radiation. Since they were discovered in 1895, they have become much safer to use for the public, but there is still potential risk with excessive use. A paper published in 2020, for example, showed an increased risk of testicular germ cell tumor (TGCT) in men who had at least 3 imaging studies (x-ray and CT) done of their abdomen, low-back, and/or pelvis.
What is normal to find on an x-ray?
There are many findings that are often catastrophised, but are actually normal to find on an x-ray. Loss of disc space (“degeneration”) is normal in people as young as 20. Small changes in spinal curvature front-to-back is normal. (Significant changes can be helped with exercise therapy.) "Misaligned" joints, which are usually caused by muscle imbalance, tightness, or spasm.
Everyone will have age-related changes on their x-ray. Everyone will experience “degeneration”. Genetics and lifestyle will determine the speed at which it happens. The goal is to minimize the speed that we experience these changes, and that can only be accomplished through a lifestyle where movement is a priority.
The fact of the matter is that we over-use diagnostic imaging in our modern healthcare system. Getting them too early can extend recovery time and lead to an increased risk of longterm disability. Though it can be tempting to want to get x-rays to find the reason you feel pain, the best course of action is to see a “rehab and movement-based” chiropractor. At Alameda Chiropractic & Ergonomics, we focus on your goals, and we treat you, not your x-rays. If you have been having pain and want to know why, then contact Dr. Whit at Alameda Chiropractic & Ergonomics. We’re here to help you feel better than ever, and stay that way.
Comentários