Imaging 101

What is imaging?

When ”imaging” is ordered, it is in order to accurately picture structures within the body that you cannot otherwise see or feel.  Depending on what signs/symptoms are present, different types of imaging is ordered.  In the Chiropractic setting, most often, we will either want an x-ray or an MRI.

When would an x-ray or MRI be needed? Is one better than the other?

X-rays (radiographs) are only useful at determining bone structure. If we are suspicious of a fracture or break in a bone, then an x-ray will see it.  If we are concerned about arthritic/degenerative changes in a joint, an x-ray will give us an indication of the extent that the bone is involved.  X-rays are also useful in determining the degree to which a scoliosis is present. (By definition, a scoliosis is diagnosed by a curvature to the left or right exceeding 10 degrees)

An MRI on the other hand, clearly shows all structures within the body very well.  This includes bones, joint capsules, fluid, ligaments, tendons, muscles etc. An MRI in the Chiropractic setting is often used to determine the cause of nerve related pain (numbness, tingling, shooting pain) or if torn muscles or ligaments are suspected.

There are pros and cons to both: An MRI is the “gold standard” for imaging as it will show just about anything the provider could want to see.  This, however, comes at an increased financial cost.  X-rays are very quick and cheap however they do not show as much information.

Take for example, a degenerative or arthritic knee.  An x-ray could show that there are changes within the joint based on how the surface of the bone looks and confirm that there is indeed arthritis present.  It however will not show the meniscus, or cartilage within joint which typically is what’s causing the dysfunction or discomfort within the knee – an MRI would show all of that.

Should I expect to get an x-ray when going to the Chiropractor? Isn’t that how they know where to adjust?

Not necessarily.  At Eastridge, we will order x-rays if we are concerned about a bone problem i.e, fracture, dislocation, scoliosis, or moderate arthritis. Some Chiropractic offices will indeed take x-rays on virtually all patients and base their adjustments and treatment plans on those images.  This is an “old school” method of determining treatment.  The benefits of an x-ray have certain limitations and costs.  A major cost is unnecessary exposure to radiation (which is what an x-ray is) and is why the American Chiropractic Association has stopped recommending routine x-rays for patients.  A major limitation is how accurately an x-ray image will show “misalignments”.  If a patient is not in a 100% neutral position, then they could look as though they have hips that are uneven, a slight curve in their spine etc.  A patient could even have a very tight muscle on one side versus the other, which could show up as a misalignment but is in fact uneven muscle tension. Certain “misalignments” found on x-rays have been shown repeatedly to be un-reproducible on follow up imaging studies: which is a major issue when relied upon for Chiropractic treatment.

At Eastridge, we focus on function to determine an appropriate treatment plan and base our adjustments on what we feel and how the patient is moving in front of us.  We will push on joints to see which ones aren’t moving as well or perform orthopedic tests to reproduce a patient’s complaint.  This exposes the patient to no unnecessary radiation and allows us to find regions that are functionally problematic on any given day.

Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropr Man Therap. 2018 Nov 21;26:48. doi: 10.1186/s12998-018-0217-8. PMID: 30479744; PMCID: PMC6247638.