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Posted on 08-29-2017

The American Chiropractic Association ACA has been in the news this week with regards to what was ( and unfortunately still is ) all too common with treatment and assessment of low back pain ...the indiscriminate use of spinal imaging ( X-ray and MRI). 

The final word from the ACA is that many commonly used tests are unnecessary. The advice given stands as follows

1. If no red flags are present ( signs or symptoms or indications of likely fracture,  cauda equina , infection or any other severe health risk ) it is advised to wait upwards of 6 weeks before obtaining images. ( this is a growingly more common practice since most acute episodes of low back pain , despite the cause can recover in this period of time)

2. Use of repeated spinal imaging ( before and after images) is Not recommended 

3. Use of passive ( heat , ice , stim) or palliative ( pain management) treatments be limited unless they assist with long term active treatment( exercise , flexibility training etc). In other words , get the patient into active care as soon as possible . 

4. Long term pain management ( pain pills) should not be provided without adequate psych screening . I think we all by now know about the opiod addiction problem in the states.

5. Lumbar supports are not recommended for long term treatment or prevention ( my belief is that they can  however help in the short term acute phase)

This is by no means the last word on treatment of acute low back pain . In my experience images can be helpful but just as often can be misleading. I have lost count on how many patients I have treated with "multiple disc herniations "  or "bone on bone " arthritis that have recovered fully. I have just as often encountered patients with clean images that have been disabled and remain unrecovered despite every attempt at treatment. 

My most pressing piece of advice is to seek help from those experienced in treating this condition, be they chiropractors, physical therapist, or medical doctors . Unless red flags are encountered, remain conservative in treatments and testing and become active and participatory in your own recovery.

Dr Ray Gaskey 

Bradford Family Chiropractic 

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