Comox Valley Chiropractor – Tips for your Health

Health tips from your Comox Valley Chiropractor

Routine X-rays Not Needed March 25, 2009

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Following up on my previous post about the necessity of X-rays, I came across a review of the literature for low back imaging.

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In 1994, the AHPR began recommending against imaging of the low back in the early stages of acute low back pain. This study was undertaken to investigate the relationship between the use of immediate X-rays for the low back and the clinical outcome of the case.

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479 articles were identified and reviewed. The authors found no differences in long term and short term outcomes between those who were X-rayed immediately and those who simply received treatment.

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They concluded that for patients who present with simple uncomplicated low back pain (no red flags present), X-raying their back did not lead to any greater improvements. Since there is no benefit to imaging the back, but there are draw backs (radiation exposure, cost), routine imaging should be avoided.

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Ultimately, every clinician has to rationalize their decisions when it comes to the assessment and treatment of their patients. I will often explain my decision not to X-ray with the fact that the X-ray result will not change my clinical management of their case. We know already from previous studies that many things are seen on X-ray and MRI that don’t have clinical relevance and may actually confuse the issue.

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If you would like to read the original article, it can be found here.

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Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

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Should I Get An X-ray? January 25, 2009

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images-6Diagnostic imaging – whether it be X-rays, CT or MRI can significantly improve patient care and give us information that can aid in recovery. When it comes to X-rays, there is some evidence that misuse of the service occurs, whether it be overuse or under-use. It is for this reason that the Chiropractic College of Radiologists (Canada) created evidence-based Diagnostic Imaging Guidelines to be used by chiropractors and other health care professionals.

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With respect to the low back and mid-back, the guidelines state that diagnostic imaging is required in the following circumstances:

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  • Mid-back or low back blunt trauma or acute injuries.
  • High-risk screening criteria for spinal injuries such as mid-line tenderness of the spine with palpation, altered consciousness or neurological problems.
  • Major trauma including pelvic trauma accompanied by inability to bear weight.
  • When spinal stenosis (narrowing of the canal the spinal cord or nerves run through) or other degenerative problems are suspected.
  • Lack of improvement with treatment, or worsening of the condition.
  • Presence of red flags – suspected underlying disease, infection or cancer, etc.
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With respect to the neck, the guidelines state that diagnostic imaging is required under the following circumstances:

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  • Acute neck trauma in someone who is older than 65, reports a dangerous mechanism of injury OR has numbness/tingling/weakness in their arms.
  • Non-traumatic neck pain WITH pain/numbness/tingling or weakness in arms.
  • Lack of improvement with treatment, or worsening of the condition.
  • Presence of red flags – suspected underlying disease, infection, cancer, instability of the neck, etc.
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It should be noted that these guidelines do not recommend taking an X-ray of every patient who walks though the door. A large number of people have simple mechanical spine pain for which further imaging is not needed, thereby sparing the patient radiation exposure and the health care system more expense. However, there are some cases (as listed above) where it is prudent to get further investigation before proceeding with treatment. Your chiropractor is trained to be able to recognize when you warrant further diagnostic imaging.

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A full copy of the diagnostic imaging guidelines for the spine can be found below.

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Diagnostic Imaging Guidelines

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Dr. Debbie Wright is a practicing Vancouver Chiropractor.

 

MRI and the Wary Chiropractor October 4, 2008

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Here in Vancouver, the wait time for a non-emergency MRI can be upwards of 6 months unless you’re lucky enough to get in on a cancellation. It is not uncommon in my office to have people recovered well before their MRI appointment comes around. It often spurs a conversation about the need to get an MRI, specifically for low back disc and nerve problems. Often, the patient will want to go for the scan anyways, just to see the state of their discs and get a good picture of what’s going on. I frequently disagree with this idea, for the simple fact that an MRI is not always what it seems.

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What do I mean by this?

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It has been well documented in the research that when it comes to the low back, MRI findings do not predict the occurrence of actual low back pain. One of the first studies on the subject was published in the New England Journal of Medicine in 1994. They took 98 people who had never had low back pain and gave them an MRI. What they found was that 52% of all people had at least one disc bulge, with 27% having a disc protrusion (more severe). 38% had a problem at more than one level, with the likelihood of finding problems increasing with age. This led the authors to conclude that the finding disc bulges or protrusions in people with low back pain is frequently simply a co-incidence.

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A better designed study was published in 2001 in the Journal of Bone and Joint Surgery.  In this study, the authors subjected 67 people without any symptoms to an MRI in 1989. They found that 31% of these people had some sort of disc abnormality. They then followed up with these same people 7 years later to determine if the abnormal findings in 1989 had lead to the development of back pain in later life.  While they did find that the second scans showed more abnormalities than the ones done seven years earlier,  the findings on the scans did not predict whether someone got low back pain or how bad the pain was.

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In my opinion, there are very good reasons why someone should go for further scans – a history of cancer, progressing neurological problems, or severe worsening of the problem to name a few. It is, however, important to realize that an MRI may just be a red herring in the search for the cause of the problem. It is especially important in this day and age of ballooning health care costs to use our resources in the wisest manner possible, and not as a first line of investigation if its not warranted.