ICA Best Practice X-Ray Guidelines Discussed
In this article I want to run through the ICA’s best practices for x-rays. These are the best x-ray guidelines in the market today. They’re effective for both injury assessments and for assessing the actual underlying cause of chronic pain in the spine.
Remember, injuries to the lumbar spine are the number one physical cause of pain and disability in the world today. Injuries to the cervical spine are number four and cervical spine injuries which cause headaches are number six.
If you follow the guidelines. they tell you exactly what you’re supposed to do.
One of the things we know about today’s spinal injury market is that doctors suffer from a lack of ability to locate the actual cause of chronic pain in the neck and back. The ICA Best Practice X-Ray Guidelines obliterate this problem. They tell a doctor exactly what to do.
The biggest problem in the chiropractic profession is that most doctors do not follow these guidelines. The guidelines are brilliant, but they’re simply not followed.
These guidelines are the key to injury assessments and to chronic pain assessments. SmartInjuryDoctors® follow these guidelines to a tee and have remarkable success doing so. The ICA developed these guidelines to define five things a doctor-of-chiropractic was supposed to be doing with his or her x-rays.
Number One: A Subluxation Assessment
Now, anybody in the chiropractic profession knows that the field of chiropractic has gone mad on this term, subluxation. In my experience, it’s gone mad because it does not understand the actual definition of the term. It likes to think that it is not a scientific term. It thinks in terms of philosophical terms and nothing could be further from the truth.
A chiropractic spine subluxation is identical to a spine instability, which is a medical term. Let me explain what these guidelines say. What they’re referring to is a chiropractic subluxation.
A chiropractic subluxation means you have a mal-aligned or mal-moving vertebra causing nerve interference. Now, where the chiropractic profession got a little off the mark on this term is that there’s also a medical term called a spinal subluxation.
A medical spinal subluxation means less than a full dislocation of the spine. That is a complete clinical entity or a complete imaging entity. A chiropractic subluxation is having mal-position, mal-alignment, or mal-movement that causes nerve interference.
Once you remove the nerve interference, you’ve removed the chiropractic subluxation. You may still have mal-position or mal-movement but it’s no longer causing nerve interference.
A lot of chiropractors thought to remove a subluxation you had to change the x-ray.
Most chiropractors are not changing the x-rays of their patients. Now, there’s a low percentage of chiropractors who are focused on realigning the spine. That’s different. It’s a small percentage of the practitioners, and I subscribe to that. I think it’s the best way to manage the health of the spine.
Now, the guidelines state that you take x-rays which show mal-position or mal-alignment and you do a motor check at each level.
Today, most doctors do not even know how to perform a motor check anymore. This used to be standard procedure. The unfortunate part is in most chiropractic college programs, students today do not know how to do an assessment for spinal injuries. It is simply not being taught anymore.
So, you’ve got mal-position or mal-alignment in motion, you perform a motor check to see if you’ve got any weakness. You do a sensory check to see if you’ve got any change in sensation. Finally, you do a pain correlation at that level.
If you have any of those three, and you have the mal-movement or the mal-position you have a spinal subluxation. It’s just as easy as that. The ICA Best Practice Guidelines say that you are looking for mal-position and mal-movement patterns. That’s what a good doctor, a good spinal doctor does.
Number Two: Determine Spinal Health by Determining the Presence of Any Soft Tissue Damage, Fractures, or Bony Pathology
Soft tissue damage or ligament damage is easy to assess. Healthy ligaments hold the spine in alignment through all its intricate movement patterns without allowing any slippages that can interfere with the nerves associated with the spine.
Simple concept, right?
When we have ligament damage, we know it causes excessive motion. Simple stress radiology shows this excessive motion if a spine misaligns under stress. This is called mal-motion. It’s clearly determined on x-ray, just like these guidelines say. These are plain film, digital x-rays that we are talking about, not DMX.
We also need to determine the severity of ligament damage.
How’s that done?
Well, you accurately measure the inner segmental motion. What a doctor needs to do is to take these x-rays (whether they take them or send the patient to an imaging center for them) and send them out to a board-certified medical radiologist to get excessive motion testing done.
It’s extremely easy to determine the severity and location of ligament injuries using this procedure. This is what SmartInjuryDoctors® do every day in their practices.
Number Three: Make an Assessment of Any Spinal Instability
What’s spinal instability? That’s the medical definition of a chiropractic subluxation. It means, mal-motion or mal-position that causes a motor, sensory, or pain problem. It’s the same thing. It’s a clinical entity, not just an imaging entity. You must have both. Both the clinical findings and the findings that reflect back to the image.
As soon as you remove the motor, sensory, or pain problem you’ve removed the spinal instability.
The First Three Steps Are Critical, Let’s Review the Last Two
After you complete the first three steps:
- Subluxation Assessment
- Spinal Health Assessment
- Spinal Instability Assessment
you move on to the final two.
Step Four, you assess for any bony pathology or any degenerative changes in the disc.
Step Five, you make an accurate count of the vertebrae. According to the ICA Best Practices this is done so the doctor can determine the best, most appropriate treatment plans for the patient’s conditions.
These guidelines, as I stated earlier, are the top guidelines in the world for spinal injury assessment with x-rays and chronic pain assessments.
Early diagnosis is the key to betterment of conditions.
It’s unfortunate today that so few chiropractors, medical providers, and osteopaths know of these and make effective use of them. Because if they were used, they would significantly reduce the costs in the market.
These guidelines also significantly improve the treatment results in the market, since they diagnose these conditions early in the patient injury cycle.
Again, it’s unfortunate that in my profession of chiropractic, the colleges offering chiropractic programs are teaching doctors great injury evaluation procedures. Injuries are the number one cause of pain and suffering in the country today.
Our colleges and providers need to understand the importance of adopting and teaching these simple procedures.
If you are interested in learning more, I encourage you to look at the ICA Guidelines for yourself. I promise you, that if you start applying it, you’re going to have happier patients that get better.