Altering the shape of the column changes the integrity of joint function and thereby stimulating degeneration over time. Building on the above, is it a reasonable assumption, that positive findings on X-ray of either existing degeneration or alterations in structure could be a reflection of ongoing perverse biomechanical changes? Again, the response is a resounding, yes. Often, patients present with what appears to be a simple back or neck strain, acute in onset, with few, if any, positive orthope-dic signs. Yet, response to treatment is slow or worse, serves to aggravate or expand the symptom complex. This could result in a negative clinical experience for both the practitioner and the patient. With appropriate use of X-ray, a more comprehensive picture of the patient’s biomechanical profile is often achieved. Underlying weaknesses, structural alter-ations or deteriorations are identified and explained. In viewing the radiographs, the patient as well as the practitioner gain deeper insight and understanding. When deterioration or structural change is evi-denced, the practitioner is better equipped to create a more realistic treat-ment program for the patient. Regardless of the science, it is logical to expect that a spine, which is showing structural compromise may require more comprehensive treatment beyond the reduction of the immediate symptoms. What do you think patients feel when a practitioner presents and explains to them their X-ray studies? I will tell you with absolute certainty, that the appropriate use of X-ray in my practice has raised patient confidence. I am told repeat-edly how thankful they are for the thoroughness of my investigations, how it has given them a much clearer un-derstanding of the genesis of their discomforts. All of which serve to im-prove patient compliance, which trans-lates into better clinical outcomes. Thomson then shares with me an actual clinical scenario: Patient X age 50 comes to me for what appears to be a simple back strain. After consult and examination, I decided not to X-ray. I saw that patient eight times. The initial response to care was positive but within a couple of months, the condition re-curred. What do you think the likeli-hood was on this patient coming back 28 Canadian Chiropractor April 2017 to me for care? He did not, and this is a scenario that is far too common in practice. Why do you think this happened? From the patient’s perspective the math is easy and pragmatic. From their experience, although the pain initially went away with care, the condition recurred. Therefore, the logical as-sumption is that chiropractic must not blame the process or the practitioner for the failure to achieve results. The absolute correctness of this hit me like a brick. By being more balanced in my use of X-ray, we have provided much more comprehensive care for our patients, seen clinical results improve signifi-cantly, with our compliance and patient satisfaction increasing exponentially. “How many of your patients do you X-ray as part of your investigative process?” have worked. The truth is, that it was not the therapy that failed; it was me, the practitioner, for not digging deep enough to uncover the root of the prob-lem. In this case, when the patient re-ceived X-rays at the direction of his medical doctor, underlying degenera-tive changes and a minor scoliosis were discovered providing the logical link between the initial problem and the recurrence. When you fail to X-ray appropriately and miss an underlying weakness or deterioration, you neglected to assess all of the variables. Now, your credibil-ity suffers and more importantly, the patient fails to receive the appropriate corrective care. Conversely, by getting a full clinical picture, presenting it to the patient with appropriate guidelines for care, the accountability now lies with the patient to comply. If he or she fails to do so, then it is very difficult to In our continued research, all indi-cations are that X-ray should become an increasingly important component of the chiropractic corrective process. With the explosion of structural changes associated with forward head carriage, sitting work environments and contin-ued expansion of sedentary North American lifestyle, comprehensive treatment strategies going well beyond pain management will be required to keep people functionally viable. Radiographic imaging will, by neces-sity and appropriateness, become a more integral tool in the diagnosis and management of dysfunctions associ-ated with these changes in lifestyle. Do you have an idea or story to share in Practice Insights? Send it to mdeguzman@ annexweb.comm www.canadianchiropractor.ca
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