Do You Need X-Rays Before Starting Chiropractic?

Ruling Out Fracture & Pathology

Yes, we are are worried about this too. If you've experienced a recent trauma (fall, car accident, etc), it's in your best interest to take x-rays to look for any signs of fracture. If you've got an injury that is chronic in nature, like a foot injury, ruling out a stress fracture is also valid. Elderly patients dealing with back pain may also be suffering from a compression fracture, which is the weight of the body causing the spine to compress without trauma. 

The pathology (disease process) we are most concerned about is anything affecting the bones or the spine. Cancer, tumors, and infection can make receiving a chiropractic adjustment dangerous and not the best course of treatment. Anyone with back pain over the age of 40 is a prime candidate for pathology and seeing spinal x-rays to make sure we are providing the safest care we can is very important. 

Normal Variants & Spondylolisthesis

There are a few things that patients are born with that can alter how we adjust an area and sometimes, if we can adjust the area at all. Eighty percent of patients are born with all the same body parts. Twenty percent of patients have different or additional bones. Extra vertebrae, less vertebrae, extra ribs, and transitional segments. Transitional segments occur where one area of the spine is transitioning into another, like where the lumbar spine gets closest to the pelvis area. Some vertebrae will take on the shape and characteristics of other areas. This is good information to have. 

Spondylolisthesis is a condition in which one vertebra is slipping over the vertebra below it. Most patients will never know they have this condition unless it gets bad. The slipping vertebra continues to slip and get worse over time depending on the patient's activities and any trauma to the area. If the vertebra slips too much, surgery is required. 

In our office, we spot spondylolisthesis on x-ray on a weekly basis. Our treatment protocol means that we will not do adjustments that involve twisting the lower spine and we are careful not to push forward on that vertebra in question. While one adjustment to a vertebra with spondylolisthesis probably won't do anything, if you continue to have chiropractic adjustments in that area the wrong way, eventually something is going to give. That will not happen in our office. 

We see spondylolisthesis with such frequency, that we have handouts in our office and provide information on daily best practices for our patients that have this condition. 

"How Bad Is My Spine?"

With every new patient, they always want to know the answer to this question. Most people have never seen an x-ray, unless they've broken an arm or a leg and they've never seen an x-ray of their spine. Now they've got a problem and they want to find out how bad it is. We start with a consultation and an examination that included range of motion, chiropractic test, orthopedic tests, and neurological tests. This helps us determine what's wrong and if you're in the right place. We want to see how your body is functioning, if your condition will likely respond to chiropractic care, and to determine if we need to refer you to another type of healthcare provider.

Next, we'll take x-rays. The x-rays will be to any areas of the spine where you either have a problem or an area we will need to treat. While many providers charge $250 or more per area of the spine, a full set of spinal x-rays in our office is $100. Our x-rays are digital, so there's no film storage or processing that will lead to other costs. The price of the x-rays is based on the time we spend taking and evaluating those images.

The next step is our evaluation and analysis of those x-ray images. We do our review for any signs of fracture or pathology, then we use spinal analysis software that allows us to take all the measurements we will need to set a baseline for where you are now and to guide us in the areas we will adjust and the direction we will need to make needed changes. 

We will also look for any signs of degeneration, which has become increasingly more common with the use of computers and smart phones. Degeneration gives us a key indicator to let us know how bad your condition is and how long you've had the problem. This gives us a much better idea as the types of recommendations we need to make for you and long your treatment plan will need to be. 

Follow Up X-Rays

While not necessary for every patient and situation, we will take periodic re-x-rays to determine how your spine has improved and any changes we need to make to your care. Follow up x-rays are just $50 in our office, and we will take just the images we need to see changes. Which x-rays we take will depend on your initial x-rays, your condition, and the types of treatment you've been receiving.

For example, patients that are receiving spinal decompression therapy will have the side view of the spine reviewed so that we can remeasure disc spaces and see how much improvement has occurred. This will give us information to decide how many additional treatments you may need and how often. 

Finally, we do our analysis and measurements all over again before reviewing your results on the next visit. At that time, we will pull up your initial x-rays and your follow up x-rays side-by-side so you can see the changes that have occurred. Without the initial set of x-rays, how would you know if anything changed? How would you know if you're doing enough at home to see the kind of the results you need?

Leg Length X-Ray Examination

We hope you can see the importance of taking spinal x-rays before beginning chiropractic care. Here's a summary:

• Rule out fracture and pathology
• Look for any variants to your spine
• Watch out for spondylolisthesis
• Determine the baseline of your spine before starting care
• Take measurements and do analysis to determine how to adjust your spine
• See follow up x-rays to see changes
• Evaluate for possible leg length discrepancy, if needed

This means you need x-rays if you have had a trauma, may have a disease process, may have a spinal variation that can't be evaluated by examination, could have a spondylolisthesis (which also can't be felt during examination), and you would like to have your chiropractor be able to determine as specifically as possible which direction to take your spine. That's just about everyone! (NOTE: We will not take x-rays of pregnant patients and rarely will x-ray children.)