Repeatability over time of posture, radiograph positioning, and radiograph line drawing: an analysis of six control groups

J Manipulative Physiol Ther. 2003 Feb;26(2):87-98. doi: 10.1067/mmt.2003.15.


Background: There is debate concerning the repeatability of posture over time, radiograph positioning repeatability, and radiograph line drawing reliability. These ideas seem to negate the use of before-and-after spinal radiographic imaging to detect and correct vertebral subluxations.

Objective: To review the results of control groups in 6 clinical control trials with before-and-after radiographic measurements taken days, weeks, months, or years apart to accept or reject the hypothesis that radiographic analysis procedures are not repeatable, reliable, or reproducible.

Data sources: Six published control groups from original data. Other data were obtained from searches on MEDLINE, CHIROLARS, MANTIS, and CINAHL on radiographic reliability, posture, and positioning.

Results: Comparison of initial and follow-up radiographic data for 6 control groups indicate that measured angles and distances between initial and follow-up radiograph measurements on lateral and anterior to posterior radiographs are not significantly different when utilizing Chiropractic Biophysics radiographic procedures. In 48 out of 50 measurements, the differences between initial and follow-up radiographs are less than 1.5 degrees and 2 mm. These measurements indicate that posture is repeatable, radiographic positioning is repeatable, and radiographic line drawing analysis for spinal displacement is highly reliable. The scientific literature on these topics also indicates the repeatability of posture, radiographic positioning, and radiographic line drawing.

Conclusions: Posture, radiographic positioning, and radiographic line drawing are all very reliable/repeatable. When Chiropractic Biophysics standardized procedures are used, any pre-to-post alignment changes in treatment groups are a result of the treatment procedures applied. These results contradict common claims made by several researchers and clinicians in the indexed literature. Chiropractic radiologic education and publications should reflect the recent literature, provide more support for posture analysis, radiographic positioning, radiographic line drawing analyses, and applications of posture and radiographic procedures for measuring spinal displacement on plain radiographs.

MeSH terms

  • Biomechanical Phenomena
  • Chiropractic / methods*
  • Controlled Clinical Trials as Topic
  • Humans
  • Observer Variation
  • Posture*
  • Radiographic Image Interpretation, Computer-Assisted*
  • Radiology / methods
  • Reproducibility of Results
  • Spinal Curvatures / diagnostic imaging*
  • Spine / diagnostic imaging*
  • Time Factors