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      X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks

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          Abstract

          To remedy spine-related problems, assessments of X-ray images are essential to determine the spine and postural parameters. Chiropractic/manual therapy realignment of the structure of the spine can address a wide range of pain, muscle weakness, and functional impairments. Alternate methods to assess such spine problems are often indirect and do not reveal the root cause and could result in a significant misdiagnosis, leading to inappropriate treatment and harmful consequences for the patient. Radiography reveals the true condition and alignment of the spine; it eliminates guesswork. Contemporary approaches to spinal rehabilitation, guided by accurate imaging, have demonstrated superiority over primitive treatments. Unfortunately, there are well-meaning but misguided activists who advocate elimination or minimization of exposures in spine radiography. The radiation dose employed for a plain radiograph is very low, about 100 times below the threshold dose for harmful effects. Rather than increasing risk, such exposures would likely stimulate the patient’s own protection systems and result in beneficial health effects. Spine care guidelines need to be revised to reflect the potential benefits of modern treatments and the lack of health risks from low X-ray doses. This would encourage routine use of radiography in manual spine therapy, which differs from common pharmacologic pain relief practice.

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          Most cited references47

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          Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial.

          To evaluate the effect of a programme of active self-correction and task-oriented exercises on spinal deformities and health-related quality of life (HRQL) in patients with mild adolescent idiopathic scoliosis (AIS) (Cobb angle <25°).
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            The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis.

            Clinicians regard lumbar lordotic curvature (LLC) with respect to low back pain (LBP) in a contradictory fashion. The time-honored point of view is that LLC itself, or its increment, causes LBP. On the other hand, recently, the biomechanical role of LLC has been emphasized, and loss of lordosis is considered a possible cause of LBP. The relationship between LLC and LBP has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP.
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              Determining the relationship between cervical lordosis and neck complaints.

              To investigate the presence of a "functionally normal" cervical lordosis and identify if this and the amount of forward head posture are related to neck complaints. Using the posterior tangent method, an angle of cervical lordosis was measured from C2 through C7 vertebrae on 277 lateral cervical x-rays. Anterior weight bearing was measured as the horizontal distance of the posterior superior body of the C2 vertebra compared to a vertical line drawn superiorly from the posterior inferior body of the C7 vertebra. The measurements were sorted into 2 groups, cervical complaint and noncervical complaint groups. The data were then partitioned into age by decades, sex, and angle categories. Patients with lordosis of 20 degrees or less were more likely to have cervicogenic symptoms (P < .001). The association between cervical pain and lordosis of 0 degrees or less was significant (P < .0001). The odds that a patient with cervical pain had a lordosis of 0 degrees or less was 18 times greater than for a patient with a noncervical complaint. Patients with cervical pain had less lordosis and this was consistent over all age ranges. Males had larger median cervical lordosis than females (20 degrees vs 14 degrees) (2-sided Mann-Whitney U test, P = .016). When partitioned by age grouping, this trend is significant only in the 40- to 49-year-old range (2-sided Mann-Whitney U test, P < .01). We found a statistically significant association between cervical pain and lordosis < 20 degrees and a "clinically normal" range for cervical lordosis of 31 degrees to 40 degrees. Maintenance of a lordosis in the range of 31 degrees to 40 degrees could be a clinical goal for chiropractic treatment.
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                Author and article information

                Journal
                Dose Response
                Dose Response
                DOS
                spdos
                Dose-Response
                SAGE Publications (Sage CA: Los Angeles, CA )
                1559-3258
                19 June 2018
                Apr-Jun 2018
                : 16
                : 2
                : 1559325818781437
                Affiliations
                [1 ]Private Practice, Newmarket, Ontario, Canada
                [2 ]Cuttler & Associates Inc, Vaughan, Ontario, Canada
                [3 ]CBP NonProfit, Inc, Eagle, Idaho, USA
                Author notes
                [*]Paul A. Oakley, Private Practice, Newmarket, Ontario, Canada L3Y 8Y8. Email: docoakley.icc@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-3117-7330
                Article
                10.1177_1559325818781437
                10.1177/1559325818781437
                6024283
                29977177
                67bc2d17-a21b-4230-86af-1da32a31a639
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 26 March 2018
                : 4 May 2018
                : 15 May 2018
                Funding
                Funded by: CBP NonProfit, Inc.;
                Categories
                Commentary
                Custom metadata
                April-June 2018

                spine rehabilitation,radiation exposure,x-ray,chiropractic,routine radiography

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