Is Xray enough or should we be using an MRI? This is a question that rarely gets asked but there are Chiropractors out there who do not even use Xray when assessing the spine. Why not use technology that can help to treat a person? If we have information at our fingertips, then it makes sense to use it so that patients can get the best outcome possible. This article is going to dive into a few reasons why chiropractors should use Xray, why someone would choose to use an MRI and what the purpose of these images are. Before I dive too far ahead, I’d like to review what an Xray is and why it is beneficial to use in a variety of health care fields for the benefits of patients.
Chiropractic and XRay
An Xray is a picture of a three-dimensional object onto a two-dimensional film. This means it is necessary to take two pictures at a 90-degree angle from each other to get a true representation of what is being imaged. Xrays should be taken in what are called series to give a full representation of the imaged body part. The problem with taking a single Xray, not in a series, is that you cannot determine the depth of the injured tissue making it a guessing game to determine where exactly in the body is the injury. If an Xray or any other diagnostic image is not taken properly or the series of Xrays are not taken properly, the images will not represent an accurate image of what is truly happening within the body. One of the keys to know about Xray is that it is best used to show hard tissue (bone) within the body. Xray are primarily used to diagnose fractures, dislocations and structural shifts of the spine.
Chiropractic and MRI
MRI images are very different. They are used to see soft tissue (Muscle, tendons, ligaments) within the body. Unlike an Xray, MRI takes pictures in layers allowing clinicians to peel off layer by layer to see where the injury is within the body. MRI’s may also be taken at 90-degree angles to see what the injury looks like when peeling back these layers from a different angle to hopefully capture the injury that is causing a patient’s symptoms. These images that an MRI is able to obtain can be used for all different body parts. There are a variety of MRI machines, most of them have a person enclosed or in an open machine for individuals who feel claustrophobic making them accessible to those individuals.
Chiropractic and Imaging
Chiropractors should be using Xray to identify how the structure of the spine has shifted away from a normal range. When this happens, the bones get stuck out of place, causing more stress to be placed on the bones above and below the stuck joint and the stuck bone itself may cause a nerve injury. Xray is paramount in knowing that the patient does not have any abnormal variations of their spine. Roughly 10% of the population has congenital anomalies, meaning they were born with a variation in their spine. It may be an extra bone, one bone less than a normal person, they may have been born with an extra rib or missing a rib. Knowing this information is paramount when taking care of a patient as a chiropractor. Would you want your doctor guessing as to which bone, he or she is adjusting because if he or she is not taking an Xray they may be adjusting the wrong bone simply because their counting one too many or one too few bones in the spine.
MRI’s are generally not the first diagnostic image that clinicians use as they are move invasive than Xray but MRI is able to obtain information about a patient that an Xray cannot. In most chiropractic cases an MRI is going to be ordered after a two-week period of conservative treatment that has not showed any benefits of care. Although it takes time for the body to heal itself there should be some sort of positive signs that the treatment is working. The reason that MRI’s are not ordered until after a two-week conservative treatment period is due to the fact that the treatment for many cases that need an MRI is actually the exact same treatment as would be recommended even after an MRI is ordered. MRI’s will help a doctor identify which disc (ligament) is injured as well as which nerve is injured. This information can play a major role in how quickly a patient recover.
In our office we use an instrument that measures for nerve inflammation which is an objective measurement for an injured nerve. Our instrumentation allows us to identify which nerve is injured without exposing our patients to more invasive imaging such as MRI unless it is necessary. Using our instrumentation, we are able to pinpoint the injured nerve and correlate that nerve to how the structure of the spine has shifted based on our full spine Xrays. I should also mention that our Full Spine Xray and our instrumentation are two objective measurements that make our office unique and help our patients receive unique results.
The goal of treatment in our office is similar to that of an orthodontist; we aim to make gradual changes over a period of time with the goal of a long-term structural correction of the spine back within a normal range. By making a long-term correction we protect the nerve system, allowing the body to heal from the nerve injury and helping the body to function at a higher level. Remember that when a person is experiencing a symptom like pain, it is a sign to that person that there is an injury and they should not be using that part of the body like they are when they experience pain. If someone chooses to mask the pain and continue to use the injured body part, they are causing more wear and tear and further damage that would have been prevented if the pain prevented them from doing what was causing the pain.
Both Xray and MRI are only diagnostic images and do not correct the cause of any problems that a person is experiencing. They are useful tools to identify a problem and should be used for specific purposes. The importance of knowing what problems exist is paramount to actually fixing the problem rather than creating a new one. Once a clinician has a full picture of what is going on with a patient, they can create a care plan to get their patient from where they currently are to where they want to be; this occurs when doctors ask patients what their goals of care are which should happen with each and every patient.
Knowing this information will hopefully give you some insight as to why it is important for chiropractors to take Xray as we as MRI’s in specific cases. At our office, Chiropractor Dr. Al Simeone specializes in NeuroStructural Chiropractic, a technique that focuses on correcting the structure of the spine back towards a normal range with the goal of removing nerve inflammation. He focuses on individuals like athletes who experience small or large traumas that cause structural shifts and nerve inflammation.