WHAT IS A SPINAL INSTABILITY?
What I want to talk about today is what is a spinal instability? It seems like there’s all this information out there about spinal instabilities. And matter of fact, I did a video on spinal instabilities six years ago, put it out on YouTube, and it was one of 245 siting’s of spinal instability at that time. I thought it was absolutely crazy that there was not more information on simple spinal instability and understanding that it was the number one cause of chronic pain and disability in the world today.
Spinal Instability Is a Clinical Entity
Obviously, if I fracture your spine and your spinal cord was about to be severed, you would have catastrophic spinal instability. These types of cases would end up in the operating room that day. So, we’re not talking about catastrophic spinal instability due to fractures. What we’re talking about here is spinal instability due to ligament damage.
Spinal instability by definition is excessive motion to the spine. The spine is designed to actually move in very specific, very minute movement patterns that all combine together. It’s both very complex, but very simple at the same time. The thing that holds all these spinal components, all these bones and joints in the right location for that movement pattern are the ligaments. When the ligaments are damaged, there’s excessive motion. It’s that excessive motion allows the spine to now move in a way that it was not designed to move, which can irritate the nerve, which can cause pain and inflammation.
It Takes More Than Just an X-Ray or MRI
It’s not something that you pick up on x-ray or on MRI alone. It’s an entity that you pick up when you detect evidence of excessive motion. The best test for excessive motion is the flexion-extension x-ray. This is a stress radiology and a very accurate measurement of what are called translation and angular patterns. Remember, the spine can move back and forth. When it moves, that’s called a translation pattern. It also angles when it moves, that’s called an angular pattern. So, we can have abnormal translation or abnormal angulation patterns. The more abnormal the pattern is, the more ligament damage there was.
These Types of Patterns Are Not Picked Up On MRI
They’re picked up on stress radiology. They’re picked up on standard x-rays. Standard digital x-rays are the best primary imaging tool to detect this. They’re very inexpensive, very easy to do. When providers get imaging done, when medical doctors get imaging done, they rely on radiologists to read those images or to measure those images. Osteopaths, same thing. Physical therapists, same thing. Chiropractors sometimes try to do this themselves.
Doctors Can Only Be Good at So Many Things
It’s highly recommended, especially in the spinal injury market that this be done independent of the doctor. In the injury market, we want doctors to be very good at treating injuries, not necessarily great at doing all the radiology studies or all the imaging studies that are possibly out there. You can’t be all and everything in the market.
Essentially, a spinal instability is very easy. It’s excessive motion. If you have excessive motion that causes a motor problem with the nerve, (In other words, something’s not able to function now. For example, I can’t move my arm as well. I’m not as strong with the muscle.) that’s a motor problem.
Each spinal level has a motor nerve associated with it which can be tested. So, the doctor’s task is to perform a motor challenge. Different types of muscle tasks for each level to see if that muscle group is strong on both sides. We also have sensory tests. When you have a nerve, there’s a motor component, there’s a sensory component, and there’s a visceral component to it. The motor is making things move. The sensory is sensing things so the body can make control adjustments. And the actual visceral is helping the body’s organs function better. All nerves have these three capacities.
The Two Things Needed to Diagnose Spinal Instability
As I said before, spinal instability is a clinical entity. It means that you have excessive motion on an imaging study that’s now causing a motor sensory or pain problem at that level. So, you have to have two things. You have to have imaging. And you have to have a doctor who knows how to do a correct spinal instability exam. Not all that common today. So, we have to grow doctors that know how to do this very simple exam procedure. It’s a very simple procedure, but not a lot of doctors do it currently in the market and it should be done every single day. Any injury patient should have this done right away.
Once you have a spinal instability, how do you get rid of it?
Well, you treat it. The ligaments have already been damaged. There’s already excessive motion. So, are you going to treat the excessive motion and make that go away? No, that’s generally permanent. But the motor, sensory, or pain problems are not permanent. They can be transient based on the care. So, the care is gauged at rehabilitating the function of the nerve to not cause pain, not lose power or force as in a motor deficit, or to regain its ability to sense. A spinal instability is no longer a spinal instability when the patient becomes asymptomatic. That’s what good doctors are trying to achieve with their patients, be asymptomatic. Really good injury doctors can actually treat spinal instability very, very well.
The good injury doctor also knows that spinal instability is the number one cause of chronic pain and has often been the thing that is most undiagnosed in chronic pain patients. Every patient knows and everyone in the market knows that if you don’t have a proper diagnosis for the condition, (I don’t care if you have cancer, diabetes, spinal pain. No matter what the condition is, if the doctor is not diagnosing it correctly) the chances of getting help are very slim.
It’s Not as Confusing as Many Think, We Just Need More Informed Providers
We need a lot more doctors in my Smart Injury Doctors program and Smart Injury Lawyers program. Throughout the country, we are teaching doctors and lawyers exactly how these procedures should be done so that they can understand exactly how and what a spinal injury patient needs.
For the chiropractic community, a spinal instability is what a spinal subluxation was and is. Today, there’s so much confusion in the chiropractic market around terminology, and subluxation is a great example of that:
- Do we treat a subluxation or not?
- Is it a “bad” or “good” word?
I look at it and say, “Look, a spinal subluxation has always been and has always been defined as a vertebra that’s either misaligned through mal static position or mal motion that causes nerve interference.”
It’s a misalignment either in position or in motion that causes nerve interference. The nerve has three things:
A spinal subluxation is identical to a spinal instability. There is no difference. So, anybody that says, “Well, I’m having a hard time. I don’t understand spinal subluxation,” definitely doesn’t understand spinal instability because they’re the same. They’re identical.
This is the number one cause of chronic pain and disability in the world today. And we need a lot more professionals that understand this very simple procedure.
It’s simple to diagnose, it’s simple to evaluate, and it’s very simple to treat. The key to it obviously, as with any condition is early detection. Which leads to early proper treatment that leads to much better outcomes. That’s what we need in the market today.