By: Steven T. Tanaka, DC
Coleman RR, et al. History or Science: The Controversy Over Chiropractic Spinography. Chiropractic History 2013; 33(1).
ABSTRACT: The historic year 1895 marked the beginnings of both radiography and chiropractic, inventions that would alter the course of world health care. These impressive developments are related in far more than merely dates of origin. Their histories have been intricately interwoven in a tapestry spanning over a century of impressive accomplishment.
But, these accomplishments have been accompanied by numerous internal conflicts within the chiropractic world. Techniques and ideologies have vied for supremacy over the course of chiropractic history. One controversy which continues today involves what at first may seem a relatively simple question: when or if to use imaging in a patient’s case. This seemingly innocuous problem has generated great debate and strife within the chiropractic community.
The biomechanical based radiographers have embraced the historical chiropractic concept that the primary reason for ordering x-rays is to evaluate spinal alignment. The pathology based radiographers have rejected the traditional chiropractic approach and feel radiography should be performed in accordance with the “red flag” philosophy. Each group seems guided by its acceptance or rejection of historical chiropractic’s view on x-ray usage and then proceeds to craft arguments in line with a preconceived belief.
It would appear that some tolerance might be expressed by both sides to allow individuals to practice somewhat to his/her own understanding without suffering the interference of either faction. Perhaps this controversy could be summed up in the worlds of the often controversial B.J. Palmer which once emblazoned outside the driveway arch of the Palmer School of Chiropractic. “Anything that you do that the majority do not do is ‘queer.’ Queer, isn’t it.”
COMMENTS: This paper was funded by the GCSS Field of Dreams. Bravo to the contributors! Basically, it discusses the schism between those whose primary (but not limited to it) to x-ray patients is for biomechanical/structural purposes. Of course, this involves pathological changes to the spine (although not necessarily the usual “red flag” reasons. The other side side says that x-rays and other imaging studies are taken for only suspected (“red flag”) bone disease and other disease processes. As we know, many in the latter camp are chiropractic radiologists who do not practice chiropractic.
Misalignment is among the major topics researched. The pathology-priority group would likely wish to dismiss misalignments as unimportant and go away as an important concept in chiropractic. There is growing literature on structural changes and health. It is interesting that the medical profession has been looking at x-rays from a structural point-of-view in recent years but mainly to improve surgical outcomes: re: the large number of articles on the sagittal x-ray view of the spine that observes pelvic angles and other considerations on other regions of the spine (see following article). Part of our profession is throwing out structural/biomechanical considerations which medical researchers are now looking at but have few resources to offer beneficial treatment for.
Costs has been a major contention with the pathology-priority group. As the authors note, medical films are typically more expensive than chiropractic films. One problem in the article are those that offer free x-rays.
Contraindications to adjustments are a major indication for imaging studies. That is important to both sides—the”red flags.”
Radiation is a major source of contention. Most chiropractors are using filtration, high speed screens and films. Some techniques do use a lot of films, eg, ASBE but are conscious of exposures, often taking non-diagnostic views for some positional x-rays (backed up by diagnostic films).
This article is a good contribution for the history of radiography in chiropractic.
Why, you may ask, does GCSS do history and x-ray papers. For one, it is affordable. More importantly, history needs to be documented. As they say, if you don’t write your history, someone else may. We’ve already seem a bit of that with GCSS.
Most important, one of our goals is to document the importance of x-ray in our practice. Dr. Coleman presented this line to GCSS: If we don’t document the use of x-rays for biomechanical, structural, or alignment as a primary rationale, there are those in our profession who have been trying to take it away,. As we are finding out through recent medical research, structural alignment can be as important as the “red flags,” and can be “red flags” in themselves. A study that this spinography article referenced found that thoracic hyperkyphosis in elderly women can be a risk for early death.
Also, researching x-rays done for predominately biomechanical/structural reasons may find better ways to take x-rays or interpret them. We can always improve what we do in our practice.