I am motivated to write this article for my chiropractic colleagues on this Thursday, December 14, 2017.

In didactic lecture I have taught that the clinical examination is more important than diagnostic imaging in diagnosing a patient’s source of pain; even going so far as to say that MRI should actually confirm the clinical examination impression. Well, this week Karran et al (1) said the same, namely that not to do and MRI of low back pain patients, but rather explain normal MRI findings before ordering the MRI; however explain in detail the clinical examination findings and the clinical impression of what the problem in their spine is. If an MRI is ordered, which is not ordered until 6-8 weeks of specialized spinal manipulation treatment, the patient will see the normal changes seen on an MRI that do not really cause their pain problem. Why is this important? Because 76% of people show disc degeneration and herniation that are not even symptomatic; and to show the patient the MRI and explain all these non contributory findings to their sets up a confused and often depression mental image of their health. DO NOT BLAME PATIENT’S SYMPTOMS ON SPINAL CHANGES THAT DO NOT CAUSE THEIR PAIN. Explain the examination findings in an enhanced reporting strategy. Intervention strategies such as enhanced reporting methods and the provision of quality information (without imaging) have the potential to improve the outcome of patients with recent-onset low back pain. As spinal specialists, we have studied together and I have taught that we treat patients, not mris.

As taught in our certification course, it is the thorough orthopedic, neurological, and physical examination that gives the diagnosis in the majority of patients. Do this examination as we present and all else follows. Ordering MRI or even plain xray diagnostic imaging will decrease as suggested by the Choosing Wisely movement of medicine today.

Respectfully submitted,

James M. Cox, DC, DACBR

(1) Karran EL, Medalian Y, Hillier SL, Moseley GL. The impact of choosing words carefully: an online investigation into imaging reporting strategies and best practice care for low back pain. Peer J. 2017 Dec 6;5:e4151. doi: 10.7717/peerj.4151. eCollection 2017.

The Canadian healthcare system may demand waittimes for spinal surgery for months or years if emergency intervention is not required. This is a frustration for many patients and the spine surgeons. In the intervening time of pain that takes a patient to his or her physician who then refers him or her to a spine surgeon, many expensive tests like MRI are ordered which may reveal abnormalities that are not of that much consequence but distract the primary care doctor who sends the patient to a surgeon.

“As a screening tool for back pain,” Dr. [Hamilton] Hall said, “MRIs are worse than useless.” Amazingly, "$24-million [is spent] annually on unnecessary MRI and CT scans in Ontario alone."

He explains his frustration as a spine surgeon is seeing patients who don't need his care - which is like 90 out of every 100 patients with back pain. He wants patients who need surgery.

Chiropractic can benefit this problem. Chiropractic physicians can diagnose and treat the 90% of patients who don't need surgery and send the surgical patients to the spine surgeons. Plus chiropractic offers this care at a lower price without always needing the expensive imaging tests for care.

For more details on the Canadian situation, please see the article Canada's Costly Spine Surgeon Backlog. Consider these chiropractic documents that show chiropractic to be

• less expensive than medical care (cost of treatment, hospitalization, compensation payments, lost workdays)  - Phelan
• effective in 29 days and 12 visits for low back pain - Cox
• effective in 13.2 visits for cervical spine - Schliesser/Kruse
• 40% less expensive when care for back pain is started with a chiropractor than a medical doctor - Liliedahl

Chiropractic has a place in healthcare to help patients and the cost of helping patients.

Consider The Cox Technic System of Spinal Pain Management for back pain relief. As a doctor, come to a Cox seminar to learn more. As a patient, consult with a local certified chiropractor for your back pain relief.

 Researchers publish their findings in the Journal of Physiciological Therapeutics that back pain patients who start care with a chiropractic physician are found to have overall lower costs than those patients who start care with a medical doctor.

 For the full article, check JMPT.