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Defending the Doctor of Chiropractic’s Practice Rights

The ICA works to defend the authority and practice rights of the doctor of chiropractic in all jurisdictions against unwarranted limitations and/or anti-competitive actions on the part of other professions.  Most recently, efforts have been undertaken to restrict the doctor of chiropractic’s x-ray authority.  Since its establishment in 1926, the ICA has recognized that radiography is a scientifically proven, clinically valid and appropriate method to evaluate multiple aspects of human spinal anatomy including identify vertebral subluxations and altered spinal biomechanics and detecting postural misalignments and pathology. The ICA believes in providing information and safeguards in rendering chiropractic care in clinical practice and the importance of making sure both the practitioner and patient are informed.  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.

Since 1972, the federal Medicare program has nationally 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 particular organizations in health care 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”.  There are other recommendations, which are aimed at the public which encourage potential patients not to seek the care of a chiropractor that takes x-rays outside these parameters and likewise, not to seek the care of any practitioner that re-x-rays patients after a period of care to track changes and record progress.

“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.

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.

This evidence based PCCRP document, published in 2006, includes an extensive list of clinical indications for taking an x-ray image of the patient with a 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 best practices and practice guidelines can be viewed online at www.chiropractic.org

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 assures the profession that we will continue to support the use of radiography in the ethical and evidence-based practice.

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