Evolving Trends in Chiropractic and Diagnostic Imaging

February 12, 2022 - Reading time: 6 minutes

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Chiropractic and Diagnostic Imaging

Back and neck pains are chiropractic domains(1). Chiropractic (manual therapy) deals with the spine structure’s realignment to address functional impairments, muscle weakness, and pain(2).

Doctors examine the spinal column and base their diagnosis through imaging tests, such as MRI (magnetic resonance imaging), radiography or X-ray, and CT (computed tomography) scan(3).

Chiropractic adjustments can help correct the body’s alignment, relieve pain, and promote healthy body function(4). These adjustments alleviate muscle and joint pains, headache, neck pain, and low back pain(5).

Chiropractors use manual treatment methods and do not prescribe medication for any conditions.

Some of the chiropractic treatments that are used involve sustained pressure on particular joints and stretching in improving joint motion and function(6).

Chiropractors use therapies, stretching, and exercises to relieve spasms, relax tight muscles, improve mobility and range of motion, and release body tensions(7).

These treatment methods are done through the use of gentle but quick hand thrust(8). An assessment that involves diagnostic imaging must be done to verify the spine’s condition before going through these treatments.

Radiography is said to offer superior results compared to other primal treatments(9). X-ray licensure for the ownership and use of the machine has been attained by chiropractors since 1910(10).

However, some people have criticized the exposure in spinal radiography(11).

In the last 30 years, the management and diagnosis of spinal pain changed from a static mechanical model (X-ray) to a patient-centered model that increased the awareness of the risk of X-rays in evaluating spinal pain(12).

Currently, 8% to 84% of patients continue to use X-rays for chiropractic consultations(13).

A study conducted in 2012 reported that chiropractor’s diagnostic imaging use is influenced by several factors, such as social influences, belief about X-ray capabilities, knowledge, and professional role and capabilities(14).

Even so, due to the positive evolution of diagnostic imaging, various trends arise.

The Evolving Trends

  • Digital Imaging Tests

        At present, X-ray is not the only imaging modality that can be used for chiropractic evaluations.

Diagnostic imaging assessments are now made easier with digital imaging that allows chiropractors to take images, adjust if needed, and send them to a radiologist for interpretation.

The move from radiographic imaging to digital imaging benefits patients by having quicker diagnosis and treatment plans while putting up with less radiation exposure.

According to a study on the advantages of digital radiography, switching to digital from film radiography may improve diagnosis due to the readily available and more objective data(15).

  • Chiropractic Training in Diagnostic Imaging

        Chiropractors need to pass the National Board of Chiropractic Examiners (NBCE) test to ensure that they have the requisite knowledge and skills to perform their functions safely and effectively(16).

Due to the transition from film to digital diagnostic imaging, Part IV of the NBCE exam was revised.

An evaluation study in The Journal of Chiropractic Education in 2020 reported that the transition to digital diagnostic imaging in the chiropractic board exam relied on empirical research, was well thought through, and aligned with the US chiropractic curricula(17).

This study has significant implications for the further development of the additional skill set of chiropractic students and faculty in digital diagnostic imaging.

The extensive training that the chiropractors undergo today includes bone and soft tissue X-ray (radiography), magnetic resonance imaging (MRI), ultrasound, and computed tomography (CT) scan.

Continuous chiropractic training ensures that chiropractors perform updated diagnostic imaging practices.

However, some chiropractors still refer patients to imaging centers to diagnose and plan treatment for their conditions.

  • Diagnostic Imaging Options

        Recently, there have been chiropractic imaging recommendations for evaluating the spine aside from plain film radiology.

A study recommended some diagnostic imaging modalities that may be helpful in the practice of chiropractic treatment. These techniques include the following(18):

Full Spine Radiography

        This radiograph type shows the whole spine that has been a vital diagnostic tool until today(19). However, full-spine radiography has garnered several criticisms over the years due to its radiation exposure.

Various developments have made this imaging technique effective and safe. Full-spine radiography is helpful in spinal alignment (scoliosis), postural disorders, and routine screening of chiropractic patients(20).

Magnetic Resonance Imaging (MRI)

        The use of MRI can be an inexpensive, specific, and sensitive method of analyzing changes in bone structure(21). Magnetic fields and radio waves help produce body structure images.

This diagnostic test is used with an intravenous contrast, which gives a clearer picture of the body’s bone structures(22).

Epidural scarring can be differentiated from residual disc material when MRI is performed in postoperative patients.

Computed Tomography (CT) Scan

        The CT scan is often used to evaluate trauma(23). This diagnostic modality can also view the spinal column and distinguish lesions in the intradural and epidural space(24).

Even though these modalities show promise in the future of chiropractic treatment, further research is still needed.

By Fay Smith


  1. Ernst, E., (May 2008), Chiropractic: A Critical Evaluation, retrieved from https://www.sciencedirect.com/science/article/pii/S088539240700783X
  2. Oakley, P. A., Cuttler, J. M., & Harrison, D. E. (2018). X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks. Dose-response : a publication of International Hormesis Society, 16(2), 1559325818781437. https://doi.org/10.1177/1559325818781437
  3. Rubin, M., (February 2020), Overview of Spinal Cord Disorders, retrieved from https://www.msdmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/spinal-cord-disorders/overview-of-spinal-cord-disorders
  4. Cleaveland Clinic, (n.d.), Chiropractic Adjustment, retrieved from https://my.clevelandclinic.org/health/treatments/21033-chiropractic-adjustment
  5. Ibid.
  6. NIH National Center for Complementary and Integrative Health, (n.d.), Chiropractic: In Depth, retrieved from https://www.nccih.nih.gov/health/chiropractic-in-depth
  7. Cleaveland Clinic, Op. Cit.
  8. NIH, Op. Cit.
  9. Oakley, P. A., Op. Cit
  10. Jenkins, H. J., Downie, A. S., Moore, C. S., & French, S. D. (2018). Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropractic & manual therapies, 26, 48. https://doi.org/10.1186/s12998-018-0217-8
  11. Oakley, P. A., Op. Cit.
  12. Jenkins, H. J., Op. Cit.
  13. Ibid.
  14. Bussières, A.E., Patey, A.M., Francis, J.J. et al. Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework. Implementation Sci 7, 82 (2012). https://doi.org/10.1186/1748-5908-7-82
  15. van der Stelt PF. Better imaging: the advantages of digital radiography. J Am Dent Assoc. 2008 Jun;139 Suppl:7S-13S. doi: 10.14219/jada.archive.2008.0357. PMID: 18539866.
  16. Himelfarb, I., Seron, M. A., et. al., (March 2020), The transition to digital presentation of the diagnostic imaging domain of the Part IV examination of the National Board of Chiropractic Examiners, retrieved from https://meridian.allenpress.com/jce/article/34/1/52/432587/The-transition-to-digital-presentation-of-the
  17. Ibid.
  18. Schultz, G., Phillipps, R. D., Cooley, J., et. al., (n.d.), Diagnostic Imaging of the Spine in Chiropractic Practice: Recommendations for Utilisation, retrieved from https://researchrepository.murdoch.edu.au/id/eprint/14114/1/diagnostic_imaging_of_the_spine.pdf
  19. Ibid.
  20. Ibid.
  21. Ibid.
  22. Ibid.
  23. Ibid.
  24. Ibid.