{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T02:50:20Z","timestamp":1787626220982,"version":"build-2736575974"},"reference-count":50,"publisher":"Scientific Scholar","content-domain":{"domain":["clinicalimagingscience.org"],"crossmark-restriction":true},"short-container-title":["JCIS"],"abstract":"<jats:p>Many chiropractors use radiological imaging, particularly X-rays, to locate and diagnose the cause of their patients\u2019 pain. However, this approach is fundamentally flawed because X-rays provide anatomical information but not functional insights. Pain, tissue damage, and injury do not always correlate directly with X-ray appearances. Given the high incidence of abnormalities found in X-rays of asymptomatic patients, the diagnostic validity of X-rays can be questioned, especially when used in isolation of the patient\u2019s history and\/or a proper clinical assessment. One may posit that their application promotes overdiagnosis, and unvalidated treatment of X-ray findings (such as changes in postural curvature), which may mislead patients into believing these changes are directly responsible for their pain. A substantial amount of research has shown that there is no association between pain and reversed cervical curves. X-ray accuracy can vary due to several factors, including patient positioning, physical and morphological changes, interreliability among doctors, and other influences such as stress, pain, and emotional state. Over the past two decades, medical boards and health associations worldwide have made significant efforts to communicate better when imaging is necessary, focusing on reducing radiographic imaging. This review describes concerns about the frequent, almost routine use of spinal X-rays in primary care for spine-related pain in the absence of red-flag clinical signs.<\/jats:p>","DOI":"10.25259\/jcis_68_2024","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T08:34:54Z","timestamp":1722501294000},"page":"28","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["An investigation into the chiropractic practice and communication of routine, repetitive radiographic imaging for the location of postural misalignments"],"prefix":"10.25259","volume":"14","author":[{"given":"Brogan","family":"Williams","sequence":"first","affiliation":[{"name":"Department of Research, College of Functional Movement Clinicians, Auckland, New Zealand,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Gichard","sequence":"additional","affiliation":[{"name":"Department of Research, College of Functional Movement Clinicians, Auckland, New Zealand,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Research and Neurosurgery, The Back Pain and Functional Movement Training Centre, Brisbane, Australia,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Louis","sequence":"additional","affiliation":[{"name":"Department of Research, Apollo Spine Rehabilitation, New Jersey, United States,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"10.25259\/JCIS_68_2024\/ref-1","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s12998-018-0217-8","article-title":"Current evidence for spinal X-ray use in the chiropractic profession: A narrative review","volume":"26","author":"Jenkins","year":"2018","journal-title":"Chiropr Man Therap"},{"key":"10.25259\/JCIS_68_2024\/ref-2","first-page":"469","article-title":"Biomechanical analysis by chiropractic radiography: Part III. Lack of effect of projectional distortion on Gonstead vertebral endplate lines","volume":"11","author":"Zengel","year":"1988","journal-title":"J Manipulative Physiol Ther"},{"key":"10.25259\/JCIS_68_2024\/ref-3","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/S0899-3467(07)60069-X","article-title":"Gonstead chiropractic technique (GCT)","volume":"2","author":"Cooperstein","year":"2003","journal-title":"J Chiro Med"},{"key":"10.25259\/JCIS_68_2024\/ref-4","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1067\/mmt.2000.108141","article-title":"Correlation and quantification of relative 2-dimensional projected vertebral endplate z-axis rotations with 3-dimensional y-axis vertebral rotations and focal spot elevations","volume":"23","author":"Coleman","year":"2000","journal-title":"J Manipulative Physiol Ther"},{"key":"10.25259\/JCIS_68_2024\/ref-5","doi-asserted-by":"publisher","first-page":"2072","DOI":"10.1097\/00007632-200008150-00011","article-title":"Cobb method or Harrison posterior tangent method","volume":"25","author":"Harrison","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/JCIS_68_2024\/ref-6","doi-asserted-by":"publisher","DOI":"10.1177\/1559325819891043","article-title":"Repeat radiography in monitoring structural changes in the treatment of spinal disorders in chiropractic and manual medicine practice: Evidence and safety","volume":"17","author":"Oakley","year":"2019","journal-title":"Dose Response"},{"key":"10.25259\/JCIS_68_2024\/ref-7","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1067\/mmt.2003.15","article-title":"Repeatability over time of posture, radiograph positioning, and radiograph line drawing: An analysis of six control groups","volume":"26","author":"Harrison","year":"2003","journal-title":"J Manipulative Physiol Ther"},{"key":"10.25259\/JCIS_68_2024\/ref-8","doi-asserted-by":"publisher","first-page":"789","DOI":"10.3389\/fneur.2018.00789","article-title":"New insights on emotional contributions to human postural control","volume":"9","author":"Adkin","year":"2018","journal-title":"Front Neurol"},{"key":"10.25259\/JCIS_68_2024\/ref-9","first-page":"88","article-title":"Sleepiness and inadequate bodily posture in the classroom: Does laziness intermediate a relationship?","volume":"4","author":"Barros","year":"2011","journal-title":"Sleep Sci"},{"key":"10.25259\/JCIS_68_2024\/ref-10","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/S0009-9260(97)80280-2","article-title":"An assessment of inter-observer agreement and accuracy when reporting plain radiographs","volume":"52","author":"Tudor","year":"1997","journal-title":"Clin Radiol"},{"key":"10.25259\/JCIS_68_2024\/ref-11","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1080\/001401398186630","article-title":"The influence of exercise and dehydration on postural stability","volume":"41","author":"Derave","year":"1998","journal-title":"Ergonomics"},{"key":"10.25259\/JCIS_68_2024\/ref-12","doi-asserted-by":"publisher","first-page":"3237","DOI":"10.1007\/s10439-010-0062-y","article-title":"Reproducibility of standing posture for X-ray radiography: A feasibility study of the BalanCaid with healthy young subjects","volume":"38","author":"Dewi","year":"2010","journal-title":"Ann Biomed Eng"},{"key":"10.25259\/JCIS_68_2024\/ref-13","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s12998-017-0147-x","article-title":"The biopsychosocial model and chiropractic: A commentary with recommendations for the chiropractic profession","volume":"25","author":"Gliedt","year":"2017","journal-title":"Chiropr Man Therap"},{"key":"10.25259\/JCIS_68_2024\/ref-14","doi-asserted-by":"publisher","first-page":"S8","DOI":"10.1080\/17437199.2012.703527","article-title":"Threatening communication: A critical re-analysis and a revised meta-analytic test of fear appeal theory","volume":"7","author":"Peters","year":"2013","journal-title":"Health Psychol Rev"},{"key":"10.25259\/JCIS_68_2024\/ref-15","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1002\/ijop.12001","article-title":"Finding theory-and evidence-based alternatives to fear appeals: Intervention mapping","volume":"49","author":"Kok","year":"2013","journal-title":"Int J Psychol"},{"key":"10.25259\/JCIS_68_2024\/ref-16","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1177\/0363546504267153","article-title":"Bone stress injuries in asymptomatic elite recruits","volume":"33","author":"Kiuru","year":"2005","journal-title":"Am J Sports Med"},{"key":"10.25259\/JCIS_68_2024\/ref-17","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1007\/s00256-020-03394-z","article-title":"Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI","volume":"7","author":"Horga","year":"2020","journal-title":"Skeletal Radiol"},{"key":"10.25259\/JCIS_68_2024\/ref-18","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3174\/ajnr.A4173","article-title":"Systematic literature review of imaging features of spinal degeneration in asymptomatic populations","volume":"36","author":"Brinjikji","year":"2015","journal-title":"Am J Neuro"},{"key":"10.25259\/JCIS_68_2024\/ref-19","first-page":"275","article-title":"X-ray scans for nonspecific low back pain","volume":"58","author":"Allan","year":"2012","journal-title":"Can Fam Physician"},{"key":"10.25259\/JCIS_68_2024\/ref-20","doi-asserted-by":"publisher","first-page":"3072","DOI":"10.1002\/art.24853","article-title":"Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain","volume":"60","author":"Henschke","year":"2009","journal-title":"Arthritis Rheum"},{"key":"10.25259\/JCIS_68_2024\/ref-21","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1016\/j.jmpt.2004.10.008","article-title":"Radiographic anomalies that may alter chiropractic intervention strategies found in a New Zealand population","volume":"27","author":"Beck","year":"2004","journal-title":"J Manipulative Physiol Ther"},{"key":"10.25259\/JCIS_68_2024\/ref-22","doi-asserted-by":"publisher","first-page":"1653","DOI":"10.1016\/j.spinee.2018.04.005","article-title":"Magnetic resonance imaging of the lumbar spine: Determining clinical impact and potential harm from overuse","volume":"18","author":"Wnuk","year":"2018","journal-title":"Spine J"},{"key":"10.25259\/JCIS_68_2024\/ref-23","first-page":"e129","article-title":"Imaging studies in patients with spinal pain: Practice audit evaluation of choosing wisely canada recommendations","volume":"62","author":"Ferrari","year":"2016","journal-title":"Cam Fam Physician"},{"key":"10.25259\/JCIS_68_2024\/ref-24","first-page":"591","article-title":"The curve of the cervical spine: Variations and significance","volume":"16","author":"Gay","year":"1993","journal-title":"J Manipulative Physiol Ther"},{"key":"10.25259\/JCIS_68_2024\/ref-25","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1007\/s00586-006-0254-1","article-title":"The association between cervical spine curvature and neck pain","volume":"16","author":"Grob","year":"2006","journal-title":"Eur Spine J"},{"key":"10.25259\/JCIS_68_2024\/ref-26","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1007\/s00590-012-0966-3","article-title":"Sagittal alignment of the cervical spine after neck injury","volume":"23","author":"Beltsios","year":"2012","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"10.25259\/JCIS_68_2024\/ref-27","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1016\/j.jmpt.2008.10.004","article-title":"Spinal curves and health: A systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health","volume":"31","author":"Christensen","year":"2008","journal-title":"J Manipulative Physiol Ther"},{"key":"10.25259\/JCIS_68_2024\/ref-28","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1002\/ca.10114","article-title":"Lumbar lordosis: Study of patients with and without low back pain","volume":"16","author":"Murrie","year":"2003","journal-title":"Clin Anat"},{"key":"10.25259\/JCIS_68_2024\/ref-29","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1007\/s00776-014-0549-8","article-title":"Association between roentgenographic findings of the cervical spine and neck symptoms in a Japanese community population","volume":"19","author":"Kumagai","year":"2014","journal-title":"J Orthop Sci"},{"key":"10.25259\/JCIS_68_2024\/ref-30","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1016\/S0020-1383(98)00184-3","article-title":"Cervical curvature in acute whiplash injuries: Prospective comparative study with asymptomatic subjects","volume":"29","author":"Matsumoto","year":"1998","journal-title":"Injury"},{"key":"10.25259\/JCIS_68_2024\/ref-31","first-page":"97","article-title":"Flawed trials, flawed analysis: Why CBP should avoid rating itself","volume":"50","author":"Cooperstein","year":"2006","journal-title":"J Can Chiropr Assoc"},{"key":"10.25259\/JCIS_68_2024\/ref-32","first-page":"103","article-title":"Ionizing radiation exposure-more good than harm? The preponderance of evidence does not support abandoning current standards and regulations","volume":"50","author":"Bussi\u00e8res","year":"2006","journal-title":"J Can Chiropr Assoc"},{"key":"10.25259\/JCIS_68_2024\/ref-33","doi-asserted-by":"publisher","first-page":"9","DOI":"10.4103\/0974-8237.199877","article-title":"Loss of cervical lordosis: What is the prognosis?","volume":"8","author":"Cacciola","year":"2017","journal-title":"J Cranioverter Junction Spine"},{"key":"10.25259\/JCIS_68_2024\/ref-34","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1097\/00007632-199309000-00002","article-title":"Diurnal variation of Cobb angle measurement in adolescent idiopathic scoliosis","volume":"18","author":"Beauchamp","year":"1993","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/JCIS_68_2024\/ref-35","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/2045-709X-21-36","article-title":"Review of methods used by chiropractors to determine the site for applying manipulation","volume":"21","author":"Triano","year":"2013","journal-title":"Chiropr Man Therap"},{"key":"10.25259\/JCIS_68_2024\/ref-36","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.echu.2018.10.009","article-title":"The chiropractic vertebral subluxation part 2: The earliest subluxation theories from 1902 to 1907","volume":"25","author":"Senzon","year":"2018","journal-title":"J Chiropr Humanit"},{"key":"10.25259\/JCIS_68_2024\/ref-37","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.echu.2018.05.001","article-title":"The chiropractic vertebral subluxation part 4: New perspectives and theorists from 1916 to 1927","volume":"25","author":"Senzon","year":"2018","journal-title":"J Chiropr Humanit"},{"key":"10.25259\/JCIS_68_2024\/ref-38","article-title":"Policies - The Rubicon Group","author":"The Rubicon Group","year":"2017"},{"key":"10.25259\/JCIS_68_2024\/ref-39","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s12998-020-00323-8","article-title":"The clinical utility of routine spinal radiographs by chiropractors: A rapid review of the literature","volume":"28","author":"Corso","year":"2020","journal-title":"Chiropr Man Therap"},{"key":"10.25259\/JCIS_68_2024\/ref-40","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s12998-015-0052-0","article-title":"The correlation of radiographic findings and patient symptomatology in cervical degenerative joint disease: A cross-sectional study","volume":"23","author":"Rudy","year":"2015","journal-title":"Chiropr Man Therap"},{"key":"10.25259\/JCIS_68_2024\/ref-41","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1097\/00007632-199702150-00015","article-title":"Spinal radiographic (Phila Pa 1976) findings and nonspecific low back pain","volume":"22","author":"Van Tulder","year":"1997","journal-title":"Spine (Phila Pa 1976)"},{"key":"10.25259\/JCIS_68_2024\/ref-42","doi-asserted-by":"publisher","first-page":"T70","DOI":"10.1016\/j.jpain.2016.01.001","article-title":"The role of psychosocial processes in the development and maintenance of chronic pain","volume":"17","author":"Edwards","year":"2016","journal-title":"J Pain"},{"key":"10.25259\/JCIS_68_2024\/ref-43","doi-asserted-by":"publisher","first-page":"838","DOI":"10.2519\/jospt.2011.3618","article-title":"Appropriate use of diagnostic imaging in low back pain: A reminder that unnecessary imaging may do as much harm as good","volume":"41","author":"Flynn","year":"2011","journal-title":"J Orthop Sports Phys Ther"},{"key":"10.25259\/JCIS_68_2024\/ref-44","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1186\/s12913-019-4773-y","article-title":"A national intervention to reduce imaging for low back pain by general practitioners: A retrospective economic program evaluation using Medicare Benefits Schedule data","volume":"19","author":"Morgan","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"10.25259\/JCIS_68_2024\/ref-45","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1136\/bmj.n291","article-title":"Do not routinely offer imaging for uncomplicated low back pain","volume":"37","author":"Hall","year":"2021","journal-title":"BMJ"},{"key":"10.25259\/JCIS_68_2024\/ref-46","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s12178-008-9037-0","article-title":"What is the role of imaging in acute low back pain?","volume":"2","author":"Lateef","year":"2009","journal-title":"Curr Rev Musculoskelet Med"},{"key":"10.25259\/JCIS_68_2024\/ref-47","doi-asserted-by":"publisher","first-page":"30","DOI":"10.4103\/jcis.JCIS_16_18","article-title":"The use of imaging in management of patients with low back pain","volume":"8","author":"Rao","year":"2018","journal-title":"J Clin Imaging Sci"},{"key":"10.25259\/JCIS_68_2024\/ref-48","doi-asserted-by":"publisher","first-page":"1841","DOI":"10.1001\/jama.286.15.1841","article-title":"The Canadian C-spine rule for radiography in alert and stable trauma patients","volume":"286","author":"Stiell","year":"2001","journal-title":"JAMA"},{"key":"10.25259\/JCIS_68_2024\/ref-49","doi-asserted-by":"publisher","first-page":"E867","DOI":"10.1503\/cmaj.120675","article-title":"Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: A systematic review","volume":"184","author":"Michaleff","year":"2012","journal-title":"CMAJ"},{"key":"10.25259\/JCIS_68_2024\/ref-50","doi-asserted-by":"publisher","first-page":"315","DOI":"10.4103\/jfmpc.jfmpc_510_15","article-title":"Evaluation of red flags minimizes missing serious diseases in primary care","volume":"7","author":"Ramanayake","year":"2018","journal-title":"J Family Med Prim Care"}],"container-title":["Journal of Clinical Imaging Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/clinicalimagingscience.org\/an-investigation-into-the-chiropractic-practice-and-communication-of-routine-repetitive-radiographic-imaging-for-the-location-of-postural-misalignments-2\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/clinicalimagingscience.org\/an-investigation-into-the-chiropractic-practice-and-communication-of-routine-repetitive-radiographic-imaging-for-the-location-of-postural-misalignments-2\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T08:35:30Z","timestamp":1722501330000},"score":1,"resource":{"primary":{"URL":"https:\/\/clinicalimagingscience.org\/an-investigation-into-the-chiropractic-practice-and-communication-of-routine-repetitive-radiographic-imaging-for-the-location-of-postural-misalignments-2\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":50,"alternative-id":["10.25259\/JCIS_68_2024"],"URL":"https:\/\/doi.org\/10.25259\/jcis_68_2024","relation":{},"ISSN":["2156-5597","2156-7514"],"issn-type":[{"value":"2156-5597","type":"electronic"},{"value":"2156-7514","type":"print"}],"subject":[],"published":{"date-parts":[[2024,8,1]]},"article-number":"28"}}