Every Tuesday, Dr. Todd Wegerski D.C. takes to Facebook live with his weekly series titled “2 for Tuesday” on Back Talking! The basics of the show; take 2 questions that are either frequently asked in the office or that have been submitted to him either through email or in the Facebook live discussion, and give 2 quick concise answers. It’s that simple. This is the pilot episode or episode 0, and in this episode Dr. Wegerski discusses his 20 years of experience helping people with back problems, as well as discussing whether x-rays are necessary when seeing a chiropractor on the first visit.
Are X-rays Necessary?
Many patients are surprised when they discover that they don’t require x-rays or imaging studies on their first visit. While imaging is an important tool, probably the most valuable part of the patient examination is the history. This is the interview portion of the exam where the physician asks questions to the patient. When a good history is acquired, the physician has a working diagnosis in his head before they have even touched the patient. What the physician is probing, asking, and listening for are so called “red flags”. These are items that get the doctors attention and require deeper investigation.
Red flags consist of the following:
- Severe or progressive neurological deficits such as loss of motor control or loss of bowel or bladder control
- Loss of reflexes upon examination
- Unexplained weight loss
- Previous history of cancer
- Long term use of steroids or immunosuppressants
- and of course Trauma, when there is suspicion of a broken bone
So the answer to the question of whether x-rays or imaging are necessary is occasionally. In the absence of red flags, we don’t consider imaging studies on the first visit. While imaging allows us to peer inside the body, it also reveals abnormalities that can potentially not be the cause of the patients pain. For example, if we were to place 3 healthy individuals into a MRI machine and image their lower back, one out of three of those individuals will show a herniated disk even though they have no symptoms of a herniated disk at all. This is called a false-positive, yes they are positive for a herniated disk, but it is false because it is asymptomatic. So I hope you can see how imaging studies can send you on a wild goose chase!
For more information or if you have any questions, you can reach out to me at firstname.lastname@example.org. If you are in the Cary or Morrisville area, you can visit me here.
To watch this episode of 2 for Tuesday, click on the video below!