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The Quiet Squeeze on X-rays: What a New Danish Study Signals for Subluxation-Centered Chiropractic

Originally published: 2025-08-26

“Only 7.3% of chiropractic patients in Denmark received radiography in 2022; among clinics with X-ray on site, usage ranged from 0% to 39%.”

What the study found

A national, registry-based cross-sectional study of 237 clinics and 657 chiropractors in Denmark mapped how often radiographs were used across 2022. Headline points:

“No measured clinic- or chiropractor-level characteristics explained the variation in radiography use.”

And while the authors of the paper focus on the variation the real shock is the cold hard facts of the overall utilization: 7.3%.

This means that only 7.3% of the patients who went to these chiropractors had an objective, valid and reliable analysis of the biomechanics of their spine prior to manual techniques being applied to their spines. Never mind not having follow up imaging to determine if their intervention resulted in any change.

This fact should be ringing in the ears of any chiropractor who worries about the future of the profession and the viability of the practice of managing vertebral subluxation.

Why this matters for vertebral subluxation management

For chiropractors who manage vertebral subluxation, radiography is not a luxury, it’s the primary objective window into the spine’s biomechanical component and a cornerstone of case analysis, planning, and follow-up. When system-level forces progressively limit X-ray access, that faction of the profession is functionally constrained, even if no rule explicitly bans the work.

This paper doesn’t adjudicate the value of radiography for subluxation care. What it does show is a practice environment in which radiography is both low and unevenly applied. That pattern is consistent with a long arc of policy pressure away from imaging, pressure that lands hardest on subluxation-centered models.

The guideline engine behind the shift

The authors themselves point to clinical guidelines, educational materials, and public campaigns as drivers to reduce imaging for spinal pain. And they tout these flawed and biased guidelines as good things ignoring the literature and guidelines that contradicts them.

In the U.S., the American Chiropractic Association (ACA) formally endorsed and adopted Choosing Wisely with recommendations that, in the absence of red flags, clinicians should not obtain routine imaging or spinal imaging for acute low-back pain, and should avoid repeat imaging to monitor progress. These positions are published by ACA, acceptance is required as a member and remain reference points across payers and institutions.

“Choosing Wisely-style policies didn’t need to outlaw X-rays; they simply made not imaging the default.”

None of that proves causation in Denmark. But the combination of (1) low national rates, (2) wide clinic-to-clinic variability unexplained by measured factors, (3) the Cartel’s control of the curriculum, and (4) international guideline pressure to “do less imaging” looks exactly like a system where access to radiography is socially and administratively discouraged, even when clinicians have the equipment.

“Change from within” has failed

For years, colleagues argued we could protect subluxation-centered practice by “working within” the big tent: ICA membership in WFC, participation in multi-stakeholder forums, and appearances at the Chiropractic Summit Group, while the other side consolidated control of education, testing, licensing, and guideline narratives. The Danish data are a clinical-practice readout of that consolidation: X-ray use is being managed down in line with external priorities, not in response to demonstrable patient-specific clinical need.

This is exactly how “professional birth control” operates: not a single switch, but a thousand quiet levers, guideline framing, reimbursement coding, teaching priorities, credentialing, and “quality” campaigns, that make core elements of subluxation management harder to teach, do, and defend. The study provides a numbers-first snapshot of the effects. Our recent publications around ICA, WFC, and the Summit simply explain the machinery behind those effects.

Read the fine print—then read the room

One sober takeaway from the paper’s limitations:

The authors call for qualitative research to understand how clinicians decide to image and for updated guidelines to reduce unjustified variation. Our view: updated guidance without pluralistic clinical aims will cement the current drift, not correct it.

Where is the Outrage from Technique Groups?

Perhaps the most remarkable silence in the face of this evidence comes from the technique groups and organizations that built chiropractic’s very identity around precise spinal analysis and correction.

The full spectrum of upper cervical techniques (NUCCA, Blair, Atlas Orthogonal, Knee Chest, Orthospinology, etc.), Chiropractic Biophysics (CBP), Pettibon, Gonstead, Pierce, and even the Upper Cervical Council of the ICA itself all rely heavily, some almost exclusively, on radiography to determine subluxation listings, biomechanical distortions, and post-adjustment outcomes.

For these groups, X-rays are not ancillary; they are the very foundation of the clinical system. And yet, when studies like this one document the steady erosion of radiography as a normative part of chiropractic practice, these groups say little or nothing. And when pressed on why they support their own destruction they couch it as “having a seat at the table” and “changing them from within”.

The truth is - there has been no change from within. That strategy has failed and failed miserably. In fact, their strategy has actually sped up the death of this model of practice. Some even believe that because of their support of the Cartel their technique will be allowed. Their practitioners meanwhile, who depend on imaging to uphold the integrity of their technique, are left increasingly marginalized, with their professional rights redefined out from under them.

All of these approaches rely heavily, some exclusively, on radiography to determine subluxation listings, biomechanical distortions, and post-adjustment outcomes. For them, X-rays are not ancillary; they are the foundation of the clinical system.

And yet, when studies like this one document the steady erosion of radiography as a normative part of chiropractic practice, these groups say little or nothing. Their practitioners, who depend on imaging to uphold the integrity of their technique, are left increasingly marginalized, with their professional rights redefined out from under them.

“The very organizations that claim to represent technique-based chiropractic have stood by while the policy machine dismantles the tools those techniques require.”

This silence is more than disappointing; it is a betrayal of the thousands of chiropractors whose livelihoods and clinical certainty depend on radiographic analysis. If these organizations truly represent their members, they should be the loudest voices of opposition to the “do-not-image” cartel agenda. Instead, many of them remain entangled in alliances with the same ICA, WFC, and Summit structures that facilitated this very outcome.

Where we go from here

We must begin by naming the bias and publicly documenting how “do-not-image” defaults disadvantage subluxation-centered models, using neutral data like this paper to show the system-wide effects.

From there, we need to rebuild standards by advancing alternative, transparent practice guidelines for spinal radiography that reflect subluxation analysis, case management, safety, and outcomes, not just narrow red-flag screening. These guidelines already exist.

At the same time, it is critical to reform the pipes: work at the statute and rule level to decouple education, testing, and licensing from the same closed set of private actors, while protecting clinician judgment where the evidence is legitimately mixed.

Finally, we must stop outsourcing advocacy. For example the ICA/WFC/Summit track record proves that waiting for insiders to defend subluxation-centered care has yielded nothing but decline. It is time to organize outside that loop.

“When access to X-ray becomes a policy taboo, subluxation-centered chiropractic becomes a policy casualty.”

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