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Do I need x-rays?

This is a question I hear almost daily in my office from existing and new patients. Most current clinical guidelines recommend (and this is my clinical opinion) that the majority of back and neck pain patients do not require x-rays in order to help them with a complaint. As a graduate of chiropractic school, I have received hundreds of hours of training in radiology (x-ray) theory, positioning and interpretation. In fact, chiropractic students have much more of their curriculum based on radiology than medical students (360 vs 148 hours). Under the guidelines of the College of Chiropractors of BC, chiropractors are permitted to take and interpret x-ray imaging for patients. A big component of that training is also dedicated towards deciding if and when a patient requires x-rays.

In my practice, I have chosen to not have x-rays in my facility because of the tendency that if a chiropractor owns an x-ray unit in their clinic or a surgeon owns an MRI unit, their patient is more likely to get x-rays or an MRI simply because the unit is there, regardless of whether the patient actually needs the imaging.

In our office, if we feel a patient requires imaging of any kind, we refer them to their medical doctor. We do this for two reasons; the medical doctor is now involved with the process and the patient has another professional helping with a diagnosis. Our patients are referred to the imaging clinics in Kelowna and the x-rays are paid for with your medical services plan. Our patients are able to have the images copied to a disc and can be reviewed in depth in our office.

X-rays can be a very useful tool in aiding a proper diagnosis, however they should be used judiciously and in combination with a thorough history and physical exam. Based on the results of the physical exam a decision can then be made regarding the need to take x-rays. The x-rays do not provide information about a person’s function. For instance, a person with moderate to severe arthritis does not always have moderate to severe impairment.

Below are some accepted guidelines of when an x-ray may be appropriate for you as a patient:

  • a significant traumatic injury (such as a motor vehicle accident)

  • If the patient has experienced any type of trauma if over age 50. This is especially true of somebody with osteopenia or osteoporosis.

  • For most patients over 70 years of age, especially if the patient’s history and examination suggests a possible bone disease (such as arthritis)

  • If the patient has had long-standing complaint that has not responded or resolved with previous chiropractic or physical therapy.


This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

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About the Author

Dr. Nimchuk graduated from Logan College of Chiropractic and has been practicing in Kelowna since 2008.  Dr. Nimchuk is one of a few full body certified Active Release Technique practitioners in the Okanagan Valley. It has become known as a very effective treatment for muscle and nerve in athletics with almost every professional sports team in North America retaining the services of an ART certified Chiropractor. Dr. Nimchuk has worked with athletes ranging from weekend warriors to Olympic champions and brings the same philosophy and treatment approach to every patient.

Dr. Nimchuk has recently opened Momentum Health, a new interdisciplinary health centre in downtown Kelowna.  The centre offers chiropractic, registered massage therapy and exercise therapy. 

In addition to being a chiropractor, Dr. Nimchuk is also registered as a Certified Exercise Physiologist with the Canadian Society of Exercise Physiology, which is the highest level of professional fitness certification available in Canada.

In addition to private practice, Dr. Nimchuk works with both the Royal Canadian Mounted Police and the Canadian Border Services Agency as a consultant to assist recruits and members reach and maintain the required health and fitness for their work. Dr. Nimchuk also a frequent speaker to business organizations and community groups on topics such as injury prevention, ergonomics and workplace health.

Please visit our website at www.momentumkelowna.com or call us at 778-484-6070.

The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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