What Is the Mechanism of Injury?
What I want to talk today about is a very, very simple concept that gets very misunderstood by doctors, lawyer, and insurers in the spinal injury market. It’s that thing called mechanism of injury. I’m a national trainer for spinal ligament injury testing and I’m probably the most renown in the market for that. I’ve been demystifying the mechanism of injury since attending a seminar where Doctors of Chiropractic were attending to get continuing education credits a long time ago.
I arrived early that day because I was scheduled to speak. I was to present a three-hour presentation on ligament injuries and how to properly address and diagnose them. There was a personal injury attorney scheduled before me, so I thought I’d go in an hour early and listen to what he had to say so I could relate what he was saying to my topic of ligament injury testing.
I was there for about half an hour, listening to the attorney go on and on and on about how you’ve got to document the mechanism of injury. I thought, “Jeez, the doctor documents it right away in the first note. It’s like auto injury, slip and fall at work or home or a sports injury. They’re documenting the mechanism right away.”
So, at the end of 30 minutes the attorney said, “What’s the most important thing to document in your notes?”
A Doctor of Chiropractic raised his hand and said, “Mechanism of injury,”
The attorney said, “Yes” and pulled out from behind the podium a brand-new MP3 player which at that time was a really big deal and threw it to the doctor.
I stood there and thought, “Wow, that is one of the strangest things I’ve ever seen before.”
I don’t think you would ever see that in a medical setting. You wouldn’t see an attorney award an MP3 player because a medical doctor got some correct answer, and I thought, “Wow, that’s really bizarre.”
So, the attorney then said, “What’s the worst thing you can do with your documentation?”
No one had an answer for that question, so he held up a can of Campbell’s soup, and I thought, “Okay, that’s it.”
I raised my hand. Remember, I was in the back, I’m the next speaker. I raised my hand and I said, “What is mechanism of injury? You just went on and on about how important this is to document. What is it?”
He stumbled at that point. He really didn’t know what it was, and that was a bit upsetting to me because it was like, “Okay, why would a speaker get up and go on and on about how important something was and not know really what it was.”
If this is so important, how could he not really didn’t know what it was, and still be considered an expert?
So, when I was walking up to the podium that day to do my lecture, I realized, “Oh my God, the doctors don’t really know what mechanism of injury is,”
From that point on, I understood how important it was to get the message across of how to diagnose these things a lot easier by just a simple understanding of mechanism of injury.
In the spine world, and especially in the spine market for chiropractors, chiropractors have studied the mechanism, what I call mechanism science. They’ve studied collision science, crash physics. These are all great things to know, right? But a gunshot wound expert probably doesn’t need to know much about guns, the bullets, the speed of bullets, how much powder is in bullets, the type of metal that’s used in a bullet, etc. They don’t need to know much about the mechanism. It’s the same for doctors.
Mechanism is always a force delivery system. As a force delivery system, it causes an injury which is the derangement pattern that’s left behind from the mechanism. Just like if a dog bites you, there’s a very specific derangement pattern. Now I could say derangement pattern, I can say wound, I can say lesion. I’m going to keep it very simple and we’re just going to say derangement pattern. They all mean the same thing.
When you injure the human body, it is impossible to injure it without deranging it in some way. There’s not one injury that anybody in the world can think of where there’s not a derangement, even a mental condition.
If you said, “Well, they were mentally deranged,” what you’re really saying is that there’s a normal mental operation that got misaligned and it’s now deranged, so even that would fall into it, but obviously I’m joking here because you wouldn’t see a physical indication for that.
What I’m saying is all human body injuries derange a body part or parts. They’re called derangements. The word impairment is the same thing. It causes an impairment. An impairment is a derangement of a body part to the extent that it doesn’t function normally any more. So there’s a mechanism, the force delivery system, and the derangement patterns that are left behind.
Now in the United States injury market, spinal ligament injuries are the most expensive injuries today.
The reason why they’re the most expensive is because many of the doctors that are treating these injuries have no idea what they look like.
I know that sounds really basic and simple but think about this. If you sent a patient in for a dog bite to be treated, but the doctor that was treating the dog bite did not know what they looked like, you would think that was strange. If you sent a patient to a gunshot wound doctor and the gunshot wound doctor didn’t know what a gunshot wound looked like, you would think that’s strange.
Oddly enough, that’s what’s occurring in the U.S. spine market today. The majority of doctors do not know what the actual injuries look like. This causes all kinds of problems, like if a person was in, say a low-impact automobile accident, and a doctor believes that they can’t have any injuries.
Well, the reason why that became so prevalent is because the doctors who were basically treating the patients did not know what the injuries looked like, so they did not get properly diagnosed.
Anyone that’s suffering from some form of chronic spinal pain usually has an underlying injury that’s never been appropriately diagnosed. The one thing that we know, whether we’re doctors, lawyers, insurers, or just patients with good common sense, is that if something is not diagnosed properly, the chances of a good result from treatment are significantly lessened. So today in the U.S. injury market, especially in the spinal injury market, it’s imperative that everyone understands what a mechanism of injury is.
When you have spine injuries, whether you have an injury in an auto accident, at work, in sports, slip and fall at home, slip and fall at a store, whenever you have an injury to the spine, it’s because of compressive and sheer force.
When you injure a spine, if you put it into a mechanism, into an event that causes excessive compression or any kind of sheer force, then we have very, very specific injury patterns that show up, and these injury patterns are very easy to identify.
Understanding the Importance of Using the Correct Imaging Tool
You use three basic imaging tools. If you think you have a fracture, obviously you’re going to use a CT. That’s the best thing that you can use. Now, there is a ligament condition, so what’s unique in the spine is that the spine has over 220 specialized ligaments that hold it together. 23 of those, so a very small number, are called discs. So, in the spine, not all the vertebrae, but the majority of vertebrae, have a disc in between them. That’s different than say your shoulder joint, your knee joint, joints in your fingers, or any other joints. They have a specialized ligament called a disc.
Now, that’s gotten overplayed because we have a thing called an MRI. When I say overplayed, all I mean by that is everybody’s been so reliant on, “Oh, did the disc herniate?”
As if a disc herniation is the only way that you can severely damage the ligaments to a spine. It’s not. If you only look at those 23 ligaments and leave the other 197 out, that’s problematic. You don’t want to do that. So we know that the MRI is very good in a limited study on ligament damage to the spine. We know that stress x-rays are another way that you can determine the location and severity of a ligament injury, so you have three imaging types.
None of them are designed to pick up what the others are designed to pick up. A CT doesn’t pick up excessive motion in the spine, the x-ray study does. An MRI doesn’t pick up excessive motion in the spine, the x-ray does. An X-ray does not pick up disc damage, the MRI does. These three main imaging types are what all doctors in the today’s market need to know and understand to properly image the injuries.
The U.S. injury market calls for the best doctors, and the best doctors are those who get the highest level of results, because that’s what patients are interested today. That’s what everybody in the market is interested in today. Whether you’re an insurer, a patient, or an attorney, that’s what everybody in the market is looking for, and there is not a doctor in the world today that can get great results with injuries that they don’t even know, number one, what they look like or how to appropriately diagnose them.
Mechanism Injury Is A Key Piece of Understanding That Everyone in The Market Should Know
It’s great to know mechanism science, but what we’re interested in today is called injury science, and injury science dictates what the injury looks like. How we best determine where it is and how bad it is, and then how we determine the best treatment for it?
Doctors, most importantly, but also attorneys, insurers, and everyone else in the market, need to understand the mechanism of injury. They also need to grasp the simple idea that mechanism is the force delivery system and the injury is actually the derangement pattern that’s left behind. That’s what mechanism of injury is today. I hope this helps demystify this idea for you.
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