Is X-Ray Important Today?
My journey into the spinal injury market came from frustrations I experienced as a practicing chiropractor. So, I have a real passion and dedication to chiropractors who wish to become masters of spinal ligament injuries.
Recently I’ve noticed a disturbing trend, the movement away from routine use of x-rays. From my viewpoint and experience as an injury provider and an injury trainer, I believe this is a big mistake.
The number one cause of chronic pain and disability in the world today is a ligament injury.
These ligament injuries cause spinal instability. The only way you can effectively and objectively evaluate spinal instability is through stress radiography. Let me remind you that a spinal instability is simply the inability of the spine to maintain alignment under load. To evaluate it, you must load the spine to see if it is able to maintain proper alignment.
Now, when it misaligns under stress, this misalignment causes excessive translation and angular patterns that can be picked up on the spine. This makes it extremely easy to determine the severity and location of a ligament injury.
It’s quite easy to identify clinically through motor testing, sensor testing, or a pain evaluation correlation if that excessive motion is causing the problem. If we determine that it’s that level that is causing the motor, sensory, or pain problem we know that we have a spinal instability.
Just like we talk about all the time, this is crucial. Spinal instabilities are the number one cause of chronic pain. The number one cause. Let that sink in for a moment and you will begin to realize the severity and potential of the injury market for those that understand what is going on.
Spinal instabilities are the leading physical cause of low back problems. The fourth leading physical cause of neck problems and the sixth leading cause of chronic headaches.
I was taught a long time ago, to not see is to not know.
You must be able to see the spine to know what is going on with the spine. It’s virtually impossible to evaluate the integrity of the spine and know what you’re dealing with unless you can see. For doctors to say that x-ray evaluation is not important is problematic.
Most people who show up at a chiropractor’s office are coming in because of pain. The x-ray is the best diagnostic tool we have available. By no means are we talking about the overuse of x-ray. We do not want to order x-rays for the heck of it or because we do not know what else to do.
This misguided movement away from x-rays has led to such confusion in the United States, that today top researchers and guidelines openly admit that 9 out of 10 chronic pain patients and injury patients do not have a specific anatomical derangement pattern identified.
In today’s injury market the number one diagnosis for lower back issues is labeled as non-specific mechanical low back pain.
This means that doctors understand that something mechanical is causing the pain but are unable to identify what that “something” is. That’s no good for anyone in today’s injury market, to not know what the cause of something is. These non-specific diagnoses are the number one diagnosis for not just the lower back, but also the neck. Without being specific these diagnoses do not contribute to effective, systematic treatment plans.
If you wan to arrive at a specific diagnosis, then you are going to need to get into x-ray evaluations. As a doctor, I personally do not see any way to determine which misalignment or how badly the spin is misaligning without the use of x-ray. X-ray properly used is the number one tool for understanding injuries and understanding what could be triggering their chronic pain.
With ligament injuries, time is everything.
If you’re an injury patient or you treat patients with a spinal injury time is critical because of how the body reacts to the injury. It doesn’t matter how the injury happened; these patients could’ve been injured:
- at work;
- in an auto accident;
- playing a sport;
- or simply from a misstep at home.
No matter the cause, these injured patients need to get to a qualified provider as soon as possible.
Think about someone injured on the job. The longer that patient goes without seeking care and receiving effective treatment, the longer they are out of action and the higher the claim costs. This delay also leads to a higher risk of long-term residual complaints, that’s why patients with ligament conditions need doctors who understand how to assess these conditions.
Today, we need more doctors who understand how to great x-ray evaluations.
There is a specific type of x-ray that is showing a lot of promise to making these evaluations even easier. Digital motion x-ray or DMX is a more advanced form of x-ray. The only problem with it is that there is minimal access to them. In the entire United States, there are only 200 units, maybe 300, up and running.
So, we need great doctors who can make an evaluation based on conventional x-ray. Virtually anybody can get access to these x-rays.
We need to be able to actually have an injured patient go to the doctor, get those x-rays, and then have an excessive motion test. This helps a qualified doctor understand how much excessive motion the patient has. Now the doctor can clinically correlate either a motor, a sensory, or a pain problem at that level. When this occurs, we have a doctor that knows what the underlying problem is that is causing the problem.
An orthopedist may shut off the pain right away using a nerve block.
Now to take it a step further, most patients get to the doctor. If the doctor understands the underlying condition, they often can treat it conservatively just fine. We have a tool available known as the nerve block. When a patient needs to have pain shut off right away, they may end up under an orthopedist’s care who performs a nerve block to give relief.
The interesting thing for us, is that nerve block positively identifies which nerve is causing the problem. When an orthopedist or pain management goes in and anesthetizes a nerve and the pain goes away, that’s the ultimate objective diagnosis of where the problem is coming from.
Excessive motion can irritate the nerves and cause the motor, sensory, or pain problem. Now, if it’s a spinal instability causing this excessive motion a patient still needs a provider who really understands how to treat the condition even after the pain is shut off with an injection.
Often the pain will return, so we need a doctor who can deal with the long-term well-being of the patient. That’s what the whole SmartInjury® Program is about, producing doctors who understand the problem’s cause and can effectively treat injured patients.
X-ray is still the most important tool for back and neck conditions.
We should always remember that the x-ray is still the best diagnostic tool we have available.
Because, it’s not okay for everyone to walk around in today’s injury market with all this chronic pain and be working with doctors who cannot tell you what exactly is causing it.
The SmartInjury® Doctor can perform an evaluation of spinal instability routinely using universally available x-rays and an excessive motion study. These are the doctors that employers, insurers, attorneys, and injured patients should be dealing with. That’s what I am creating today with our program, a supply of providers who can shift the injury market from misunderstanding and ineffective treatment to effective diagnoses and care that gives patients relief from debilitating chronic pain.