Advanced Imaging. Part 2.

April 2023 blog.

Image: International Journal of Spine Surgery

Chiropractors are now able to prescribe advanced medical imaging tests as well as conventional x-rays for their patients. They can request magnetic resonance imaging tests, scans, ultrasounds or a bone density test, according to the needs of the patient.  In order to provide these new professional services, chiropractors must demonstrate that they have acquired the necessary skills and knowledge and have completed the necessary additional training.  In this second part of our blog, we discuss specific situations in which your chiropractor may prescribe advanced imaging

Case #1.   A 38-year-old man visited his chiropractor with lower back pain radiating to the right leg.The pain had started 3 weeks earlier and for no known reason.Following the consultation, examination and x-rays, the chiropractor diagnosed lower back pain (lumbago)caused by vertebral subluxations, as well as “radiculopathy” (a pinched nerve), which is an irritation of the spinal nerve roots. After 4 weeks of chiropractic treatment combined with exercises done at home, the back pain was almost completely resolved and the symptoms in the lower right leg improved by 50%.However, by the next visit, the leg pain was back and was now associated with a lack of strength and loss of sensation in the calf and several toes.Upon discussion, the patient and the chiropractor agreed to continue the chiropractic care and the exercises for another 2 weeks.Unfortunately, the pain and other symptoms persisted and even seemed to be getting worse despite all efforts to improve the situation.

According to the INESSS guide on the optimal use of MRI for musculoskeletal pain in adults (guide d’Utilisationoptimale de l’IRM dans les cas de douleursmusculosquelettiques chez les adultes): “In the presence of non-traumatic lower back pain, an MRI is generally not recommended before a minimum period of 4 to 6 weeks of conservative treatment unless serious disease is suspected.An MRI is indicated in the presence of significant or progressive neurological deficits or in cases of suspected infectious disease or tumour pathology.”In this case, with the patient suffering from significant or progressive neurological deficits despite 4 to 6 weeks of treatment, MRI could be indicated.

It is important to mention that when a chiropractor prescribes specialized imaging, the associated costs will not be covered by Quebec health insurance, so the patient will have to pay out of pocket.The patient may also choose to be referred to a physician who could prescribe medical imaging covered by the Quebec health insurance plan.

Case #2.   A 22-year-old tennis player arrives with pain in her right shoulder that started a few weeks earlier, during a match.The young woman had already had X-rays which were normal.The chiropractor diagnosed rotator cuff tendonitis and started treatment with a series of rehabilitation exercises.The player also reduced the frequency and intensity of her workouts.The pain slowly improved, so that three months later she was able to compete almost normally.During a tournament, however, she felt a sharp pain in her shoulder while serving.She went backto her chiropractor, but this time things did not go as well.Several months of treatments and exercises were necessary for a meagre 20% improvement.The chiropractor suspected a shoulder tendon tear.He recommended an ultrasound of the shoulder.

Diagnostic ultrasound is very useful for evaluating superficial soft tissues (tendons, muscles, etc.), i.e.close to the surface.The rotator cuff of the shoulder is a good example.This examination does not expose the patient to any radiation and is less expensive than an MRI.

In conclusion, it should be noted that chiropractors can only prescribe advanced medical imaging examinations when these examinations are within their scope of practice, within their skills and knowledge and of course, when required by the patient’s condition.