Chiropractors and Medical Doctors are trained in the diagnosis and treatment of back pain, but they don’t always do a good job. One of the most common mistakes that these doctors make is that they are relying too much on X-ray and MRI imaging to try to track down people’s pain symptoms. I know, this seems totally counterintuitive, but it’s absolutely true. I have patients who come in all of the time who ask, “Don’t you think we should do an X-ray or MRI to see what the problem is?” My answer most of the time is – NO. Other times they will bring in a fresh X-ray or MRI report and tell me their doctor ordered the imaging to find their problem. Most of the time, that X-ray or MRI actually does more harm than good. I’ll explain.
Doctors Don’t Always Use Best Practices
Medical doctors attempt to diagnose low back pain by ordering x-ray imaging (which is expensive) and MRIs (which are even more expensive), both of which can miss the real cause and tend to lead to worse outcomes. Medication may be prescribed instead of education on how to avoid future episodes. Some chiropractors will use routine X-ray imaging, even without symptoms to determine whether an alignment issue is a cause. Non-specific diagnoses such as “nonspecific lower back problem” or “lumbar strain” are given when there is no specific injury found on examination. Neither of these approaches is based on the current best evidence in managing most cases of low back pain. The American College of Physicians and the American Pain Society have advised the following since 2007:
Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence).
Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence).
Unnecessary X-Ray and MRI imaging can lead to more problems.
As I mentioned they can often lead to worse outcomes. Studies have shown that people who receive MRI imaging have higher rates of disability. X-ray findings that something is crooked or misaligned reinforces patient beliefs that their back is “bad” even though these findings aren’t usually associated with back pain.
If this is the case, then why do some doctors continue to go straight to the imaging? Unfortunately, some lack current training to make an accurate diagnosis using the best techniques. Other times, doctors may rely on imaging as a scare tactic to convince you to follow a treatment plan. Either way, unless your doctor cites a reasonable expectation of what they might find, you should be suspicious of their approach. For example, they may find scoliosis which is a curvature of the spine. It’s not very common but there are estimates that 30-50% of people with scoliosis will have low back pain. However, low back pain is very common. About 80% of people in the US will have low back pain at some point in their life. Also this means that 50-70% of people with scoliosis didn’t have low back pain. So when an X-ray shows scoliosis, it doesn’t mean that this is the cause of the problem. You can’t take an X-ray or MRI and see pain. You should be suspicious of a doctor who tells you that your back pain is due to scoliosis or even degenerative changes in the spine. I know, that sounds counter-intuitive but these changes often get called “arthritis” or “degeneration” when really most of them don’t necessarily cause pain and they tend to be quite common as people age. I can’t even count the number of people who have seen these things on imaging and their attitude becomes that they are doomed to have back pain for the rest of their life. That’s just not true.
What We Do Different at Body of Health Chiropractic & Wellness Center
The chiropractors at Body of Health Chiropractic & Wellness Center use an individualized approach for each patient to find the root cause of their symptoms so that they can get better faster! We never use scare tactics. We want our patients to be full of hope and empowered to overcome whatever challenges they may face. Because we understand the evidence, we don’t use imaging as a first line of attack in managing low back pain unless there are specific factors in play such as trauma or red flags for serious disease. Otherwise, we may order X-ray and/or MRI if we find that our treatment approach isn’t getting you the desired results and we need more information. If your doctor wants to do X-rays early without one of these conditions being met, my advice is to seek a second opinion. Unnecessary imaging does more harm than good; patients who are given this diagnosis may have worse outcomes as they believe their pain to be the result of something serious instead of normal muscle tension issues. This leads them to take more medications which can lead to dependency on these substances for relief from chronic back pains. Doctors need to remember evidence based guidelines when ordering any type if treatment including diagnostic tests like MRIs and X-rays. We’re here for you! Send us a message today if your doctor has recommended an unnecessary test or procedure so that we can help you get the best care.