The Importance of Vigilance in Chiropractic Practice

Chiropractic practice often revolves around treating what many consider to be “garden variety” complaints: low back pain, neck pain, and headaches. For many practitioners, addressing these issues can become routine. However, it’s crucial to remember that for the patients, these issues are far from routine—they disrupt their lives, impair their ability to work, care for their families, and enjoy a good quality of life. Often, patients turn to chiropractors as a last resort, having exhausted traditional medical treatments without success. In these moments, chiropractors have the opportunity to profoundly impact lives by reducing or eliminating pain and restoring function.

The story of Ted, a seventy-four-year-old retired construction laborer, exemplifies this point. Ted presented with low back pain, a common complaint among chiropractic patients. However, his pain felt “different” this time and wasn’t responding to his usual self-care methods. Ted’s story underscores an essential lesson for all healthcare providers: what appears to be a routine case can sometimes mask a more serious underlying condition. Therefore, it is imperative to follow systematic protocols and remain vigilant.

Ted’s Case: A Deeper Dive

Ted’s case began with the usual steps: obtaining a comprehensive health history and conducting a physical examination. Ted had a history of chronic low back pain, a hernia repair, and prostate cancer surgery that left him incontinent. He was otherwise medication-free and had quit smoking fifteen years ago. His physical examination revealed pain on deep palpation and limited range of motion, which are common in elderly patients with a history of physically demanding work. The initial diagnosis leaned towards low back pain secondary to degenerative arthritis.

However, to confirm this diagnosis and rule out other potential causes, Dr. Steve decided to take X-rays of Ted’s lower back. This decision aligns with the practice of using imaging to get a clearer picture of the underlying issues, a common and effective strategy in chiropractic care (Hartvigsen et al., 2018).

The ABCs of Reading an X-Ray

Dr. Steve utilized a mnemonic device from his training: ABCs, which stands for Alignment, Bone, Cartilage, and Soft tissues. This systematic approach ensures that nothing is overlooked.

  • Alignment: Ted’s spine showed a normal gentle curve but a distinct offset of the last lumbar vertebra relative to the sacrum, known as spondylolisthesis. This condition, while potentially painful, did not fully explain the new, “different” pain Ted was experiencing.
  • Bone: The shape and density of Ted’s vertebrae were mostly as expected, but the top two lumbar vertebrae had a scalloped appearance, raising a red flag.
  • Cartilage: Narrowing of the disc and facet joint spaces indicated degenerative joint disease, a typical finding in elderly patients.
  • Soft tissues: This is where the critical discovery was made. Dr. Steve noticed a garden hose-like shape along the front of Ted’s spine—an indication of an Abdominal Aortic Aneurysm (AAA). This finding was confirmed when the aorta’s diameter measured 4.3 centimeters, exceeding the threshold for aneurysm (Lederle et al., 2000).

The Role of Routine in Detecting the Unusual

Ted’s case illustrates how crucial it is to adhere to a systematic approach, even in routine cases. The ABCs mnemonic helped Dr. Steve uncover an AAA, a potentially life-threatening condition that could have been missed without careful examination. Abdominal Aortic Aneurysm is a serious condition where the aorta becomes enlarged and weakened, risking rupture and sudden death (Johnston et al., 1991). Ted’s condition required immediate medical attention, and the follow-up ultrasound and CT scan confirmed the need for surgical intervention.

A Lifesaving Referral

After identifying the aneurysm, Dr. Steve contacted Ted’s primary care physician, who arranged for an immediate ultrasound, followed by a CT scan and eventually, surgery. This collaboration between chiropractic care and traditional medical practice ensured that Ted received the necessary treatment promptly. Ted’s story ended positively, with the successful repair of his aneurysm and resolution of his back pain.

The Importance of Vigilance and Systematic Practice

Ted’s story serves as a powerful reminder of the importance of vigilance and systematic practice in healthcare. Chiropractors, like all healthcare providers, must remember that patients can present with multiple issues simultaneously. What seems like a routine problem can sometimes hide a more serious condition. By following the ABCs of X-ray analysis and the principle of “stop, look, and listen,” healthcare providers can better serve their patients and potentially save lives.

In conclusion, while chiropractic practice can become routine, it is essential to approach each case with the same level of thoroughness and vigilance. The ABCs of X-ray reading and the principle of stopping, looking, and listening are not just good practices—they are vital tools in ensuring patient safety and effective care. Ted’s story is a testament to the importance of these practices and the life-saving potential they hold.


Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., … & Buchbinder, R. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367.

Johnston, K. W., Rutherford, R. B., Tilson, M. D., Shah, D. M., Hollier, L., & Stanley, J. C. (1991). Suggested standards for reporting on arterial aneurysms. Journal of Vascular Surgery, 13(3), 452-458.

Lederle, F. A., Johnson, G. R., Wilson, S. E., Chute, E. P., Hye, R. J., Makaroun, M. S., … & Makhoul, R. G. (2000). The aneurysm detection and management study screening program: validation cohort and final results. Archives of Internal Medicine, 160(10), 1425-1430.

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