Sign you up for pre-paid treatment plans
Deciding how long it will take to recover is notoriously unpredictable, some patients have improved significantly quicker than expected. We don’t think it is ethical to sign you up for a batch of treatments with discounts if you pre pay, our patients pay after each visit and they decide if they wish to make further bookings.
Treat more than one patient at a time
Our treatments are individual and confidential, we do not treat several patients at a time in the same room. We want to focus our attention and skills on one person at a time and be able to discuss any specific and personal matters in private. A family member or friend is always welcome to accompany a patient, if the patient wishes.
Insist you attend a health talk prior to your consultation
We aim book those that wish to start treatment as soon as convenient. While we present talks to various parts of the community there is no obligation to attend a talk, there is time during our consultation and treatments to ask any questions and understand more about your condition and what helps or hinders it.
Routine x-rays
We are trained to take and read x-rays but we don’t take or request them routinely. This is because for most people with mild and severe back pain the x-ray has been shown to provide no additional information that is proven to be useful for their treatment. The harm from over exposure along with the additional time and costs have been shown to outweigh the benefits (1).
In fact one study (2) compared the group of people with low back pain who had an x-ray and found their health status and pain to be worse than a similar group who didn’t have an x-ray! One reason for this is the negative psychological effect of being told they have arthritis or wear and tear in their spine. This tends to cause more worry about their condition (fear avoidance) and they do less physical activity, both factors increase their pain and it may take more treatments for them to recover.
Conversely patients often feel an X-ray or scan will “get to the bottom” of their condition, particularly if they’ve suffered for some time but x-rays don’t reveal much about the muscles, ligaments and nerves. They are useful to see fractures and some pathology. MRI scans are useful to see a muscle ligaments and disc herniations trapping a spinal nerve, but about 30% of 20 year olds with no pain or back injury have these when scanned, rising to 43% of 80 year olds (3). So a scan is only useful alongside a good orthopaedic and neurological exam (which we aim to do) and in the context of the patient’s history and complaints, it is not helpful to “treat the scan instead of the person”.
We are able to refer for an x-ray (or other scans like MRIs) when we see it clinically relevant. However the The Ionising Radiation (Medical Exposure) Regulations 2017 clearly state that a clinician must be document and justify the benefits of the exposure.
1) Current evidence for spinal X-ray use in the chiropractic profession: a narrative review, 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247638/pdf/12998_2018_Article_217.pdf
2) The role of lumbar spine radiography in the outcomes of patients with simple acute low back pain https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-8077.2005.00122.x
3) Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/pdf/nihms-696022.pdf