How X-Ray Analysis Can Improve Treatment Outcomes with Chiropractic Care

X-rays provide chiropractors with objective tools to use to determine the best treatment plan to correct misalignments in the spine and joints with the goal of producing long-term results.

On November 8th, we celebrate the International Day of Radiology, which falls on the anniversary of the discovery of x-rays. Do you have x-ray machines in your office and are you skilled in reading and analyzing the x-rays you take?

Dr. Luke Stringer: Yes. We are an objective chiropractic clinic, in regards to how we like having objective findings to dictate our treatment recommendations. And an objective finding is having x-ray analysis performed on the spine.

So, yes, we have an x-ray machine. I’d say the majority of chiropractors do. Ours is a digital system. Digital systems are awesome, taking images quickly and efficiently. And yes, as you go through chiropractic school, there is a heavy, heavy component on radiology and the things that fall within radiology. So, reading x-rays, both biomechanically and then obviously medically in regards to figuring out breaks, fractures, inflammation, lesions, et cetera.

So yes, we have x-ray systems in our office and chiropractors are absolutely skilled in reading them. We do our own analysis. There’s a really cool piece of software out there called PostureRay. A DC came up with a really cool piece of software where they digitally analyze your x-ray and essentially give you biomechanical feedback. So, give you to the millimeter, and to the percent, of your spine and where it shifted, if it has shifted, which is awesome because it creates real detailed analysis for the chiro so we can put together a real detailed treatment plan. It’s awesome for our patients to be able to leave the office with some objective findings of what’s causing and driving the pain.

Also, we’re an integrated practice, so multidisciplinary chiropractic, physical therapy, medical services. We actually have all our x-rays read by a DACBR. A DACBR is a chiropractor who obviously graduated as a chiropractic student, however, then spent several years extending their scope of practice to officially be a chiropractor version of a radiologist. So, we have a DACBR read all of our films. And they’re essentially the chiropractor version of a radiologist. And yeah, it really helps us make great clinical decisions. It helps our patients understand what’s causing and driving the pain, and gives us some objective data we can work off and show improvement as we go through the treatment plans.

What role do x-rays play in Chiropractic BioPhysics, the method of chiropractic care that you specialize in?

Dr. Luke Stringer: Chiropractic BioPhysics is the most researched form of chiropractic. It’s evidence based, and it’s essentially leading the research field in spinal research that’s in chiropractic and the medical field. A little bit of history, the chiropractor who essentially invented, per se, the Chiropractic BioPhysics technique, is actually a structural engineer by trade, and also had a math PhD, so obviously extremely bright. And he took both math and engineering principles and applied it to the spine, particularly biomechanics of the spine. And then from there essentially just developed this technique and then his son took it over, Dr. Deed Harrison. He’s one of the leaders in the spinal research field.

Chiropractic BioPhysics separates itself from other chiropractic care based around spinal traction. So, research is very clear when you are under treatment for neck pain, lower back pain, and you are seeing a chiropractor, you’re getting adjusted and or you’re seeing a physical therapist, you’re stretching, you’re doing the rehab, there’s a very good chance that when you are under treatment, you’re going to be feeling a lot better during treatment.

Chiropractic BioPhysics specializes in the analysis of your spine structurally in terms of its biomechanics, and then putting you through corrective care, which involves spinal traction. So, spinal traction is essentially doing the opposite of what your spine’s doing. So, if your head’s gone forward and you’ve lost the curve, the idea is to bring that head backwards and improve the curve. And all the research is very clear, the groups that were just doing the chiropractic and physical therapy felt better, but their follow-ups at 6, 12 plus months, they felt the same and/or worse than they did before they started treatment. The group that performs Chiropractic BioPhysics and performs spinal traction, at their follow-ups, they felt the same and or better than they did when they finished treatment. So, when we speak to our patients, we always offer our patients, what would they like to do?

In regards to their treatment plan, one of the options is would you like to go through chiropractic biophysics, which is a corrective care plan which offers more objective, long-term results. Essentially by doing that, we can have x-rays pre-care, we can have x-rays post-care, and then we can objectively show improvement. And that improvement, as long as we’re proactive in our habits outside the office is a long-lasting improvement. So, it’s really cool to practice with a technique with so much research and evidence-based practice behind it, and also offer our patients more a long-term solution rather than just a quick fix.

Can the x-rays you take in your office reveal the condition in the shape of the spine as well as the joints?

Dr. Luke Stringer: Yes, absolutely. So, our x-rays are designed to do several things. One, the condition of the spine. So, is that spine healthy? Do we have any inflammation, any lesions, any breaks, any fractures, any degenerative changes, any spinal conditions such as DISH, because we need to know about that to make a good clinical decision on treatment referral, et cetera. And then Chiropractic BioPhysics is studying the biomechanics of the spine, which is the shape of the spine. So, that’s essentially what our x-ray analysis is done for, to rule in and rule out conditions, and then obviously also to biomechanically adjust the shape of the spine.

Now any moveable joint in the body is x-ray able. Now when you x-ray joints, you’re not necessarily looking for alignment per se, although if you’re x-raying the wrist, you want to check the alignment of the bones in the wrist, same in the ankle. And then in the other joints you’re looking for loading patterns. So, in the knee, do we have shifts, do we have degenerative changes? So, x-rays are great, the gold standard for bone. So, any joint in the body that moves, we can x-ray the joint to figure out alignment, any structural damage, any other quirky things that might be going on in the joint.

In what ways can you customize a chiropractic treatment plan based on the x-ray findings?

Dr. Luke Stringer: All our plans are customizable to the patient. Clinical findings and goals of that patient drive clinical recommendations. So, for example, if I came in and my spine was in alignment, my top bone of my neck was on my bottom bone, I had a 42 degree curve, and I had neck pain from waking up, sleeping on the couch, that’s been present for two weeks, that patient’s treatment plan’s going to be a lot shorter in duration than someone who’s coming in with neck pain for three years. We’ve got a two-inch shift forward in the neck, we’ve got an 80% reduction in the neck, they’ve got phase two degenerative disc disease in several discs in the neck. So, obviously their care plan is going to be a lot different to the former’s, because it’s going to take a lot more time, energy, and effort to get that spine back in alignment and obviously clean up those patients’ symptoms.

So, x-rays allow us to make good clinical decisions and obviously all those clinical decision dictate type of treatment. So, physically what you’d be doing within the visit, how often you need to be coming in, and for how long a period of time.

During ongoing chiropractic care, would you take x-rays again to assess the effectiveness of the treatment?

Dr. Luke Stringer: Yes, absolutely. Depending on the patient. Some patients might come with some really quirky misalignments where the head’s gone forward, it’s also shifted laterally to the left, and then it’s rotated to the right. They are really hard conditions to treat, and the setups and contractions are quite complex. So, obviously when we set the patient up, we want to be checking in on the patient and making sure that setup’s doing its job and we’re seeing some good change. And if it’s not, figure out why not, and then obviously make changes.

Our patients who go through corrective care, always like to have x-rays taken at the end of the corrective care, because they’ve been applying themselves two, three times a week for eight to twelve weeks and they want to see objective change through all their hardworking endeavors. So, we typically take x-rays at a bare minimum at the beginning of the treatment plan, at the end of the treatment plan, we’ll go over a pre-treatment plan x-ray, a post-treatment plan x-ray.

If our patients have been consistent with their treatment, particularly with their traction, then we’re going to show them some good objective change. Patients love to see that. It’s essentially just validating all their hard work and effort. And also for that they’re going to get long-term improvement.

From there, we can obviously recommend ongoing treatment outside the office in regard to their need to continue doing traction at home that we can prescribe. We recommend a sit-stand desk, everyone should be using those. We’re educating our patients on postural breaks that they need to do throughout the workday, staying out of flexion, so chin into your chest. Follow up on the rehab people, those muscles that we’ve got active to keep the spine alignment, make sure they follow through on those. So yes, x-rays pre- and post-treatment allow us to make good, clear decisions and then obviously show the effectiveness of the treatment that we just performed.

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