International Chiropractors Association

ICA Recognizes Radiographic Studies Are the Standard of Practice in Chiropractic

For Immediate Release, September 27, 2017:  Since its establishment in 1926, the International Chiropractors Association (ICA) has recognized that radiography is a scientifically proven, clinically valid and appropriate method to evaluate multiple aspects of human spinal anatomy, identify vertebral subluxations, altered spinal biomechanics, postural misalignments, pathology and in providing information and safeguards in rendering chiropractic care in clinical practice.  All fifty of the US States have incorporated authority for doctors of chiropractic to apply diagnostic x-ray procedures in their respective scopes of practice and all US chiropractic colleges teach x-ray procedures and analysis.  Nationally, since 1972, the federal Medicare program has either required by statute or, recognized and accepted x-rays of the spine as a primary method of identifying and documenting a vertebral subluxation.

Recent public statements by some organizations participating in the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign are recommending that radiographic imaging should not be used to assess adults with acute low back pain until after six weeks, barring the presence of certain indicators termed “red flags.”  These same recommendations, originally intended to improve the practice of medicine, will discourage potential patients from seeking the care of a chiropractor when these medical standards are inappropriately applied to the practice of chiropractic. 

“The ICA believes that these ‘recommendations are out of line with the established standards of chiropractic practice, ignore the large body of clinical and outcomes data that demonstrates the utility, indeed clinical wisdom of such procedures, and clearly can and will, if followed unquestioningly, place patients at risk by delaying or denying diagnostic procedures that have been proven to best serve patients’ needs,” said ICA President Dr. George Curry. “These new “Choose Wisely” recommendations have provoked a massive wave of concern, indeed outrage, on the part of scores of chiropractic organizations and, practitioners in the thousands, as simply an unwarranted, intrusive and harmful set of recommendations that can only reduce the safety and clinical effectiveness record of chiropractic. This amounts to nothing less than an attempt to apply an inappropriate medical standard to the practice of chiropractic,” Dr. Curry added. 

ICA’s Clinical Guidelines Committee has carefully evaluated these so-called “Choose Wisely” recommendations and determined that while these recommendations may be applicable for the medical physician who might only proceed to prescribe or recommend pharmaceuticals, they are out of line for the practicing doctor of chiropractic since in the vast majority of cases, doctors of chiropractic apply a specific, directional force to the spine through the chiropractic adjustment process. Doctors of chiropractic are responsible for assessing the spine to appropriately determine whether or not the patient has a vertebral subluxation and determining if, when and how a chiropractic adjustment may be applied.  X-ray studies are a standard clinical tool providing necessary objective clinical evidence and are a critical component of numerous chiropractic techniques taught in CCE accredited programs.

“We would refer any chiropractic practitioner, other health professional or member of the public for that matter to the ICA Practicing Chiropractors’ Committee on Radiology Protocols (PCCRP) For Biomechanical Assessment of Spinal Subluxation in Chiropractic Clinical Practice, said ICA Guidelines Committee Chair Dr. Joseph Betz. The ICA PCCRP document provides the chiropractic profession with an extensive, rigorous review and appraisal of radiology protocols and their utilization in the context of chiropractic care settings, in conjunction with an exhaustive evaluation of the chiropractic and biomedical literature, including risk benefit ratios, measurement and patient positioning, and patient population applications.  The PCCRP Guidelines were the only chiropractic x-ray guidelines ever accepted for inclusion in the National Guideline Clearinghouse (NGC), serving under the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.  The ICA Best Practices and Practice Guidelines can be viewed online at www.chiropractic.org/bestpractices.  

This evidence based PCCRP document, published in 2006, includes an extensive list of clinical indications for taking an x-ray image of the patient such as suspected subluxation, history of trauma, including birth trauma, motor vehicle accidents, falls, postural and  for the procedure by chiropractic profession to identify multiple clinical components including fractures, congenital, developmental, postural biomechanical and degenerative conditions, ruling out pathologies, assess the indications for appropriate options in performing a chiropractic spinal adjustment for both the acute and non-acute patient.  The ICA's Best Practices and Practice Guidelines also support comparison x-ray studies to effectively utilize certain techniques as it provides valuable information detailing the effects of the chiropractic adjustment and to assess and anticipate the patient's response to care and future progress.

The ICA encourages all chiropractors who feel that their ability to practice with the necessary tools is being threatened to raise their voice and be heard.  Further, the ICA wishes to assure the profession that we will aggressively support the use of radiography in the ethical and evidence based practice of chiropractic.  We look forward to standing with you against this unfortunate, divisive and needless affront to the profession.