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Michigan Association of Chiropractors Issues Resolution on Recent X-Ray Guidelines

Focus is on Radiographs in Acute Care Phase

Without mentioning the recent decision to adopt restrictive guidelines on radiography by the American Chiropractic Association (ACA), the Michigan Association of Chiropractors (MAC) issued a resolution promoting the right of clinicians to choose the clinical procedures that best address patient needs.

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The American Chiropractic Association (ACA) recently launched a campaign to "re-brand" the trade organization that includes a new pledge, new logo and new tagline.

According to their website the ACA is going to be:

1. More rigid in their standards
2. Adopting new standards of care
3. Made up of the most principled and accomplished chiropractors

One example of the new standards being promulgated by the ACA are its new x-ray guidelines. The ACA released a list of five tests it states are commonly ordered but not always necessary in chiropractic care. The recommendation includes the admonition to not take spinal x-rays in acute low back pain patients unless there are so called Red Flags and to never take repeat x-rays to monitor progress. Teaming up with ABIM Foundation and Consumer Reports, the ACA’s President David Herd DC referred to these as “unneeded or overused services” and that following these recommendations would yield the “best possible care”.

The MAC joins numerous groups and organizations that have already issued press releases and statements rejecting the ACA's adoption of these guidelines including the Foundation for Vertebral Subluxation, Illinois Prairie State Chiropractic Association, Chiropractic Biophysics and the International Chiropractors Association to name a few.   

The following is the full text of the Michigan Association of Chiropractors Resolution:

Whereas, the Michigan Association of Chiropractors (MAC) is a professional organization whose mission is to protect and enhance the chiropractic profession through organized leadership, education, and the promotion of the chiropractic discipline and practice; and, 

Whereas, the MAC works to protect the right of individual chiropractors to choose the clinical procedures within the chiropractic standard of care and practice, that he or she believes best address the patient’s complaint and/or diagnosis; and, 

Whereas, the “performance, ordering, or use of x-ray” is included in the definition of “chiropractic” in the Michigan Public Health Code [MCL §333.16401(e)]; and, 

Whereas, radiology is a scientifically proven component of the chiropractor’s clinical practice, as the role of diagnostic radiology is clinically useful in evaluating multiple aspects of human spinal anatomy, biomechanics, postural faults, misalignments, vertebral subluxation complex, and other pathologies; and, 

Whereas, one of the primary tasks of the MAC is to educate and inform Michigan’s chiropractic community, other organizations, and the public on the latest requirements and trends in chiropractic treatment protocols; and, 

Whereas, the MAC recognizes the need for scientific evidence to support chiropractic care provided by chiropractors across the state and the nation, and that the utilization of rational, evidence-based clinical guidelines and “best practice” documents are critical ways to implement research findings into clinical practice; and, 

Whereas, the MAC also recognizes that clinical practice guidelines have the potential to streamline health care delivery, improve patient outcomes, and increase safety by using best available scientific evidence and broad consensus to develop appropriate care parameters; and, 

Whereas, the MAC further recognizes that clinical practice guidelines do not, cannot, and should not represent a “set-in-stone” prescription of care, as they do not take into account such critical factors as the judgment of the chiropractor and the individual circumstances and values of the patient; and, 

Whereas, the MAC is aware of recent publications from the American Board of Internal Medicine (ABIM) Foundation, as part of the ABIM Foundation’s Choosing Wisely® campaign, regarding the appropriateness of radiological spinal imaging for patients with low-back pain during the six weeks after onset in the absence of red flags; and, 

Whereas, the MAC Board of Directors fundamentally rejects the statement in this document that states: “Do not obtain spinal imaging for patients with acute low-back pain during the six (6) weeks after onset in the absence of red flags.”; and, 

Whereas, the MAC recognizes that entities such as insurance companies and insurance claims reviewers are using this publication to deny the use of radiographic studies to patients and deny reimbursement for such studies to chiropractors; and, 

Whereas, in 2008, the MAC Board of Directors, while stipulating that no guideline can replace the clinical decisions made by a chiropractor in the course of treating an individual patient, passed a Resolution promoting and supporting the evidence-based science for appropriate radiologic evaluations of patients seeking chiropractic care developed by the Practicing Chiropractor’s Committee on Radiology Protocols (PCCRP); and, 

Whereas, the MAC Board of Directors has not been made aware of any subsequent evidence-based radiological guidelines or protocols that would supersede or render obsolete the PCCRP’s Guidelines, including the Choosing Wisely® document from the ABIM Foundation; 

Now, therefore, be it resolved by the MAC Board of Directors, that we re-affirm our Resolution to promote and support the PCCRP’s Guidelines. 

Now, therefore, be it further resolved by the MAC Board of Directors, that all Michigan doctors of chiropractic who utilize radiologic evaluations in their practice, familiarize themselves with the PCCRP X- ray Guidelines, which can be accessed online at 

Approved by formal Board of Directors vote on October 5, 2017.


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