The CBP&lt;sup&gt;®&lt;/sup&gt; mirror image&lt;sup&gt;®&lt;/sup&gt; approach to reducing thoracic hyperkyphosis: a retrospective case series of 10 patients

2021

Self Cite

There is a faction within the chiropractic profession passionately advocating against the routine use of X-rays in the diagnosis, treatment and management of patients with spinal disorders (aka subluxation). These activists reiterate common false statements such as “there is no evidence” for biomechanical spine assessment by X-ray, “there are no guidelines” supporting routine imaging, and also promulgate the reiterating narrative that “X-rays are dangerous.” These arguments come in the form of recycled allopathic “red flag only” medical guidelines for spine care, opinion pieces and consensus statements. Herein, we review these common arguments and present compelling data refuting such claims. It quickly becomes evident that these statements are false. They are based on cherry-picked medical references and, most importantly, expansive evidence against this narrative continues to be ignored. Factually, there is considerable evidential support for routine use of radiological imaging in chiropractic and manual therapies for 3 main purposes: 1. To assess spinopelvic biomechanical parameters; 2. To screen for relative and absolute contraindications; 3. To reassess a patient’s progress from some forms of spine altering treatments. Finally, and most importantly, we summarize why the long-held notion of carcinogenicity from X-rays is not a valid argument.

Section: Assessing Spinopelvic Parametersmentioning

confidence: 99%

Radiophobic Fear-Mongering, Misappropriation of Medical References and Dismissing Relevant Data Forms the False Stance for Advocating Against the Use of Routine and Repeat Radiography in Chiropractic and Manual Therapy

2021

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“…54 -56 Thus, the universal pressure to restrict X-ray use in spinal rehabilitation goes against the evidence-based practice of many patient-centered, spine-specific, biomechanical treatment approaches that are readily available, taught in graduate and postgraduate education, and practiced by a significant number of clinicians. 11 -45…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, RCTs provide evidence for spine correction from physiotherapy back extension exercise programs to reduce thoracic hyperkyphosis, [20][21][22] as well as physiotherapeutic scoliosis-specific exercise programs (eg, Schroth methods) for reducing scoliosis spinal curvature. [23][24][25][26] Clinically weaker evidence (from case control, case studies/ series) exists supporting the effectiveness of many other nonsurgical generalized spine rehabilitation approaches, for example various methods to reduce forward head translation, [27][28][29][30] thoracic hyperkyphosis, [31][32][33][34][35][36] scoliosis, [37][38][39][40] pseudo-scoliosis, 41,42 spondylolisthesis, 43 and methods to increase thoracic hypokyphosis. 44,45 There are in fact many spine and posture rehabilitation approaches that use spinal X-rays for the diagnosis and screening of biomechanical parameters essential in guiding patient-centered, spine-specific rehabilitation approaches to reduce various spine displacement or subluxation types 46 in the effort to enhance patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Are Restrictive Medical Radiation Imaging Campaigns Misguided? It Seems So: A Case Example of the American Chiropractic Association’s Adoption of “Choosing Wisely”

2020

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Since the 1980s, increased utilization of medical radiology, primarily computed tomography, has doubled medically sourced radiation exposures. Ensuing fear-mongering media headlines of iatrogenic cancers from these essential medical diagnostic tools has led the public and medical professionals alike to display escalating radiophobia. Problematically, several campaigns including Image Gently, Image Wisely, and facets of Choosing Wisely propagate fears of all medical radiation, which is necessary for the delivery of effective and efficient health care. Since there are no sound data supporting the alleged risks from low-dose radiation and since there is abundant evidence of health benefits from low-doses, these imaging campaigns seem misguided. Further, thresholds for cancer are 100 to 1000-fold greater than X-rays, which are within the realm of natural background radiation where no harm has ever been validated. Here, we focus on radiographic imaging for use in spinal rehabilitation by manual therapists, chiropractors, and physiotherapists as spinal X-rays represent the lowest levels of radiation imaging and are critical in the diagnosis and management of spine-related disorders. Using a case example of a chiropractic association adopting “Choosing Wisely,” we argue that these campaigns only fuel the pervasive radiophobia and continue to constrain medical professionals, attempting to deliver quality care to patients.

“…The common X-ray is an essential tool for doctors and manual therapists in the treatment of musculoskeletal and neuromusculoskeletal diseases and conditions associated with poor posture and spinal deformity. 1 – 10 There has been an ever-expanding evidence base substantiating the effectiveness of nonsurgical rehabilitative methods for the treatment of posture and spinal deformities, such as forward head posture, 11 – 20 cervical hypolordosis/kyphosis, 14 – 21 thoracic hyperkyphosis, 22 – 29 thoracic hypokyphosis, 30 , 31 lumbar hypolordosis/kyphosis, 32 – 37 and scoliosis. 38 – 41 …”

Section: Introductionmentioning

confidence: 99%

“…The common radiograph is an invaluable tool that will continue to be a “go to” procedure to assess and monitor treatment effects related to improving posture with contemporary treatment approaches. 11 – 41 There are, however, many fears concerning the exposure of radiation (ie, radiophobia), particularly for the acquisition of diagnostic medical X-rays (including computed tomography [CT] scans). 42 – 47 …”

Section: Introductionmentioning

confidence: 99%

Radiophobia: 7 Reasons Why Radiography Used in Spine and Posture Rehabilitation Should Not Be Feared or Avoided

2018

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Evidence-based contemporary spinal rehabilitation often requires radiography. Use of radiography (X-rays or computed tomography scans) should not be feared, avoided, or have their exposures lessened to decrease patient dose possibly jeopardizing image quality. This is because all fears of radiation exposures from medical diagnostic imaging are based on complete fabrication of health risks based on an outdated, invalid linear model that has simply been propagated for decades. We present 7 main arguments for continued use of radiography for routine use in spinal rehabilitation: (1) the linear no-threshold model for radiation risk estimates is invalid for low-dose exposures; (2) low-dose radiation enhances health via the body’s adaptive response mechanisms (ie, radiation hormesis); (3) an X-ray with low-dose radiation only induces 1 one-millionth the amount of cellular damage as compared to breathing air for a day; (4) radiography is below inescapable natural annual background radiation levels; (5) radiophobia stems from unwarranted fears and false beliefs; (6) radiography use leads to better patient outcomes; (7) the risk to benefit ratio is always beneficial for routine radiography. Radiography is a safe imaging method for routine use in patient assessment, screening, diagnosis, and biomechanical analysis and for monitoring treatment progress in daily clinical practice.