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What is a true expert?

What is a true expert?

by | Jul 31, 2019 | Articles

What is a true expert?

What is an expert, and particularly, what is an expert in the spinal soft tissue injury market or the spinal ligament injury market?

What is an expert? What actually is an expert? I want doctors to start to be able to identify experts, so when they have questions, when they’re looking for advice, they’re looking for education, that they are, indeed, searching out experts.

So, what is an expert? An expert is somebody who has specialized knowledge due to experience. The only way you gain that specialized knowledge is through experience. Today, there are so many so-called experts in the spinal soft tissue injury market. And here’s a fact that I’m going to point out. Spinal ligament injuries are the number one cause of chronic pain and disability.

All our experts, all of our expertise of the past has led to this condition being the number one cause of chronic pain and disability in the market today. We’ve got to find better experts, but before we do, we must define what is an expert. So, again, an expert is somebody who has specialized knowledge through experience, and through the application of that knowledge.

I’m going to give you an example. We can have an engineer, and engineers are the ones that design and build bridges. Professors of engineering teach our students today. They can be an expert at bridge building, so that professor could be described as an intellectual expert at bridge design, bridge building, and every aspect of putting a bridge together. But yet, they’ve never built a bridge, so they don’t have any experience in the thing that they are an expert in. To me, that’s not a real expert. That’s a paper expert. That’s an educational expert. That’s an ivory tower expert.

Let’s take the student, who goes out and builds six tremendously large impressive bridges that help us all. That expert has specialized knowledge. Let me tell you what happens with that expert. That expert went through the same education that every engineer did, right? So, just because you have an engineering degree, you could say, “Hey, I read a ton of books on bridge building”, and today, you could be a highly renowned expert. As a matter of fact, you could have a lot of titles behind your name showing that you’re an expert, but you have never built a bridge.

So, here’s the difference. The person that has built a bridge knows what information is important and what information is not. The key to an expert is that they can differentiate what is important and what is not, whereas the non-expert thinks everything is important.

When you are new to a subject, one of the biggest issues that you have with the subject is that everything seems so important. You’re not sure what is important and what is not. So, today, we need to start relying on experts. That expert, that expert that’s built a bridge, can come in and say, “You know what? 90 percent of what this professor is teaching actually does not apply and is not really necessary to understand in order to build that bridge.” That’s the difference between a true expert. A true expert can tell you what is important and what is not important.

In the area of spinal ligament injuries, we have a lot of so-called experts, but we don’t have a lot of experts when it comes down to determining the severity and location of a ligament injury, using excessive motion testing, and using MRI with excessive motion testing.

What is excessive motion testing?

Excessive motion testing is designed to pick up the imaging biomarker of a ligament injury. A ligament injury leaves two imaging bio-markers behind. An imaging biomarker is a specialized feature that determines the diagnosis of a condition. An imaging biomarker for a fracture is a separated bone on x-ray.

An imaging bio-marker for ligament damage is two-fold. Excessive motion is picked up and measured. When you’re in the injury market, it should be measured independent of the provider. Providers should not make these measurements themselves simply because they are going to use that information for determining a treatment plan, determining impairment, determining if they need a consult with a spinal fusion surgery consultant, a spinal fusion surgeon. They’re going to use that to make return to play parameters decisions for contact sports. They’re going to use this information, and the information is significant, so it should be done independent, unbiased.

You have excessive motion testing, and you have MRI. Today, there’s been such an over-utilization of MRI for spinal ligament injuries, and MRI is not even one of the better tests. It’s a good test for a disc. Remember, you have 23 discs and over 220 specialized ligaments. MRI is great for a disc study, but it’s not great to pick up excessive motion.

MRI was never designed to do this, and excessive motion is one of the most damaging aspects of a spinal ligament injury. It’s picked up with stress radiology and accurate measurements, but again, doctors, smart doctors, SmartInjuryDoctors, know that those results should be done independent. Results from an MRI should not be read by the treating provider. Disc herniation should be determined outside of the treating provider, and the treating provider can use that to make better treatment decisions.

Excessive motion testing should be done outside of the treating provider. Now, why do I say that? Well, because as far as somebody in the market that has utilized … What I said is an expert is somebody that has experience. I have as much or more experience in the market utilizing these procedures as anyone. So, I have direct experience with it, so I’m coming from complete experience, and there are not enough doctors in this market that have experience with excessive motion testing.

  • How does it combine with MRI testing?
  • How do you use it then to get better treatment results?
  • How do you use it to focus on and enhance and change your treatment plan?
  • How do you use it to manage your patient get better results?
  • How do you use this information to make sure that your patient doesn’t have chronic pain at the end of your care?
  • How do you use this information to make sure that your patient is seriously reducing their risk for long term residual complaints?
  • How do you use this information to make sure that you’re doing everything that you can to make sure that the person is not disabled or debilitated from these types of injuries?
  • How do you use this information to align with other factors of care that you can use in order to get better results?

That’s what an expert can do. When we look at excessive motion testing, I think if a provider has maybe 500 studies under their belt, they’re getting some really good expertise in this area, maybe 200. But, how many providers in the market today have actually sent out 200 plus injury patients and then monitored to the results of the test, clinically correlated it for the spinal instability level, accurately treated it, and then sufficiently documented it, so it makes everyone’s life easier? How many experts in the market are there that have done that? It’s very few, and they’re very rare. That’s what we’re producing with SmartInjuryDoctors for back and neck injuries. That’s what makes these doctors incredibly unique.

What I wanted to talk about was an expert. When you find an expert that has 10, 20, 30 years of experience, and you want to know about that subject, you want to get with that expert, and you want to have that expert take 20, 30 years of what they’ve experienced in the market and get that information in a week.

That will hyper-escalate the evolution of the science. So, that bridge builder that’s built 10 bridges can tell you a lot of things, and if new education programs and new information is based off of that information, then you’re going to have a serious expansion in the science of bridge building or a serious expansion in the science of spinal ligament injuries or a serious enhancement of the science of the treatment of spinal ligament injuries.

Now, spinal ligament injuries, remember, they’re not sexy. You’re never going to see a St. Elsewhere or House, where the provider actually went, “Oh my gosh, why are they having debilitating headaches? Oh my gosh, why are they having debilitating neck pain?” And only to find out 50 minutes later through all of this testing and weaves in and out of the story, that it was a simple spinal ligament injury, and that it was only due to the sheer acumen of the doctor’s, House, in this case, brilliance that he actually picked it up.

That’s not what you’re going to see with this, but the doctors that are really good with this condition should be the most significant doctors in the market today because this market causes … This condition causes the most chronic pain and the most disability.

I am always hit by, “Well, this expert or this person said this.” And my question is always, “Okay, well how much excessive motion testing have they done?” I don’t mean how much have they said they’ve done. How many studies have they sent out? How many times? How much have they taken that information and relied on it clinically? It’s almost always none. So, they’re relying on an expert that has little or no experience in the subject that they’re asking the expert to give their experience on or their education on.

Get with the providers. Get with the experts that really do have expertise, and they are not just talking about it. They are not just reading about it. They haven’t read everything there is to know about it. They actually have applied their knowledge to get a very specific result.

That’s what you’re looking for. That’s what we’re creating in the SmartInjuryDoctors’ programs. We’re creating doctors that are relying on the expertise in very, very small niche subjects, and the most important subjects there is in the spinal ligament injury market.

Don’t get caught following an expert who’s really not an expert. Search for really good experts. Glean what you can, and then take their information and take it to the next level because that’s what we need in our injury markets today. We need the top doctors in our injury markets, and those top doctors should have access to all the injury patients as far as I’m concerned. The best doctors in the injury market should have the most injury patients, and our whole work, employers, insurers, should be directing those injured patients to those doctors.

For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.comor check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

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Why You Should Use Spinal Kinetics for Excessive Motion Testing

Why You Should Use Spinal Kinetics for Excessive Motion Testing

by | Jul 31, 2019 | Articles

Why You Should Use Spinal Kinetics for Excessive Motion Testing

Spinal Kinetics is a medical ligament injury testing company that’s nationwide. And its whole purpose is to assist with the accurate diagnosis of spinal ligament injuries. Spinal ligament injuries leave excessive motion factors behind on stress X-rays. Spinal Kinetics is a medical testing company whose board-certified medical radiologists accurately measure the excessive motion. They have their own system and they’ve trademarked their own procedure term called computerized radiographic mensuration analysis (CRMA®). I’m going to tell you why you should use them with my own story.

My name is Dr. Cronk. I’m the COO (chief operating officer) of Spinal Kinetics. Some people may say I’m biased, so I want to tell you how I became the COO of Spinal Kinetics. Back as a treating provider around 1995, I learned what excessive motion testing did. And I also learned the AMA guides and the spinal injury model and how much emphasis the impairment guides actually put on excessive motion problems with the spine. As a treating chiropractor, this made sense to me. And what the tests did for me is it allowed me, for the first time in my private practice, to be able to determine the severity and the location of the patient’s injuries right away. Week one within their care I knew what was going on and how bad and how severe their injuries were.

I also knew that I as a Doctor of Chiropractic could’ve done my own testing. I could’ve done my own analysis. The problem that I had was in the injury market, these injury findings were so significant that I wanted the leverage of having the results be unbiased. Somebody could look at me as a provider and say that I’m biased. I’m trying to manipulate results of testing. Doctors are quite often attacked for trying to over-diagnose something or over evaluate something or trying to make it look a lot worse or appear a lot worse than it is in order for them to enrich themselves. I understood in the injury market; this was a very real phenomenon. But I also understood that the findings themselves were significant. These findings were causing a significant impairment to occur in the impairment guides. These findings were also findings that were used to pre-authorize surgical fusion surgeries at the time. I knew the results were significant.

And I also knew as a treating provider that I was treating a very serious condition. The whole world said this was an extremely serious condition. And I was taking patients on a regular basis and taking them three, four, five, six months out with care and being able to get them fantastic results.

  • No chronic pain.
  • No activities of daily living problems.
  • No duties under duress problems.
  • No loss of enjoyment or life factors.
  • No disability whatsoever.

So I wanted to, as a provider, show everyone that I was treating what the medical science of the day says are serious injuries. I wanted to show that I, and myself as part of a profession called chiropractic, was able to treat these and handle these. And I knew it would not be looked upon correctly if I was coming up with the results myself. That’s why I used an unbiased third party. At that time in the market it was called Spinal Logic Diagnostics.

So I sent out for excessive motion testing on every single one of my patients that I thought had a spinal ligament injury when they were in an injury scenario. And so that’s why today I believe the findings of excessive motion testing on stress radiology are so significant. They’re so important that they should be done in an unbiased manner. As a matter of fact, my experience and my opinion say that insurance providers should not even accept the results unless they’re done independent because who can tell the provider that’s actually trying to manipulate the results and the provider that’s not trying to manipulate the results? The only way you can guard against that as an insurer is if it’s done by an unbiased third party. And doctors are not good enough. I have seen doctors in the market … I have talked to services in the market personally where they’re actually using a non-doctor or a non-licensed professional to do these services. You absolutely cannot do that.

The process should be independent. Spinal Kinetics has a process called computerized radiographic mensuration analysis (CRMA®). There are many, many doctors and service providers that are saying that they do CRMA® or that they do these computerized radiographic mensuration procedures. You can’t google, unless you use Google, you don’t use Safari and google. You use Google. You can’t get a CRMA unless you’re doing it through Spinal Kinetics.

What makes Spinal Kinetics unique?

This company was founded by Dr. Steven Brownstein. Steven Brownstein is a board-certified medical radiologist. And he was also one of the first radiologists that really understood excessive motion testing. And he also understood stress MRIs because he had also developed and had centers with upright weight-bearing MRI. He was trying to press into the environment the significance of stress testing. And that’s why I went with and joined hands with Dr. Brownstein. He’s a pioneer in the area of stress testing and stress radiology. One of the things that we developed together is a process. We use board certified medical radiologists. All of our studies go through two licensed professionals that are trained to actually accurately do these studies. If we have ratable findings in the company, they are often reviewed by a third licensed professional. We are the only company in the country that does that.

You can have a group buy some sort of a software or do some sort of a service and most of the time the providers are not familiar with the software, they are not familiar with the testing, or they have little experience with it at all. I don’t know of a company in the country that has more experience with this testing than we do. Nobody else in the market is doing this type of testing with this type of review with medical providers themselves. If you can find an independent service that has as much experience as Spinal Kinetics and does a better job than Spinal Kinetics, I’m going to be the first one to tell you to use it. The only thing I’ve ever been after with my career is accurate testing. You want accurate testing. You want the testing to be unbiased.

You as a provider want to focus on what you do best, which is treatment. You don’t need to know all the ins and outs of how images are acquired, how studies are accurate or how they’re found to be inaccurate. You don’t need to know any of that. You don’t want to know any of that. And you don’t want to have any experience with it. And you also don’t want to rely on those that don’t have experience with it. You want to rely on those that do. And that’s Spinal Kinetics.

Spinal Kinetics has quality control second to none. As a company, Spinal Kinetics is changing the way these injuries are worked up so that conservative care providers that understand these injuries can get on the injury right away. Time matters in these injuries. Accurate diagnosis matters. The sooner and the quicker the patient get an accurate diagnosis … I’m talking about within week one, within days if possible, they should get an accurate diagnosis so that good providers who know what they’re doing with the treatment of spinal ligament injuries can get to treating the patient, so the patient reduces their risk.

Remember with spinal ligament injuries today, 50 percent of the people who have them are never going to fully recover. And 30 percent of that 50 percent are going to have debilitating conditions as a result of their injury. We don’t need more injury doctors. We need better injury doctors. And that’s what Spinal Kinetics is trying to assist, the best providers in the market in understanding exactly what that patient’s injuries are. Remember, there’s over 220 specialized ligaments in the human spine. There’s 23 discs. MRI is good for those 23 discs. CRMA is good for all of the ligaments. And those providers that understand that are some of the best providers in the market. Those are the providers that we want to work with.

For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.comor check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

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Learn more about dr. cronk

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246 Tierney Drive, Suite 1,
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1-800-940-6513, ext 700

[email protected]

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701 Richards Ave
Clearwater Florida 33755

[email protected]
Call Lee Ann at 1-800-940-6513, ext 700

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The AMA Permanent Impairment Guides

The AMA Permanent Impairment Guides

by | Jul 31, 2019 | Articles

The AMA Permanent Impairment Guides

In this article I want to offer a short rundown of the AMA Guides to Permanent Impairment. Before we talk about what these guides offer, let’s discuss the term impairment.

Impairment is a loss. A Loss of use or a derangement of any body part, organ, or organ system. For example, if I had my arm amputated, it would obviously be a loss. If I lost the use of something, that would also be a loss. Let’s say I cut the nerve to my arm and can no longer use it as before, that would be a loss as well.

A derangement is any body part’s derangement. Derangements usually occur due to damage, due to an injury of some kind. It’s a derangement of any body part, organ, or system.

The AMA Impairment Guides, Easy to use but what are they?

These guides could be called the AMA Guide to Body Derangement, or Guide to Permanent Injury, or the Guide to Body Damage. They all mean the same basic thing. But the AMA settled on Permanent Impairment Guides. There are several editions: Third, Fourth, Fifth, Etc.

These guides are the most consensus driven way for a doctor to look at any injury and report the effect that the injury has on the person’s activities of daily living. The impairment guide takes an injury and determines what needs to be present for that criteria to be met and then assigns a percentage of loss to that injury.

Like in the above example, if I lost my arm, the guide states that is an impairment and it applies a percentage of loss to it. This says that consensus wise, we the AMA, we doctors agree that is what the injury is and what it does to a person.

It’s the only accepted guideline in the world for determining if a condition is permanent or not. That’s why they’re called the Permanent Impairment Guides. So, it’s a way to determine if the person has a condition that causes permanent problems for the patient. In other words, it changes their life. That’s why they’re important.

These guides are extremely important in injury work because there are questions that need to be answered.

The first thing that needs to be addressed is whether the injuries are permanent. A doctor can give his opinion and say, “Yes, they’re permanent.” That is like a doctor looking at a patient without the benefit of an x-ray and stating that a patient has a broken leg. We need something to verify the condition.

That is what these guidelines do, they say, “This is what all the doctors agree to and if there is body damage this is the negative impact it is going to have on the patient’s life.”

For treating doctors doing injury work, this is a must. Right?

You’re stuck in a medical-legal situation, facing depositions and trials and an attorney is going to ask the question:

How did you arrive at the fact that the condition was permanent?

For example, with a spinal derangement it says is there a fracture? Is there ligament damage that causes excessive motion? Is there ligament damage that cause a herniated disc?

Remember, when you injure a body part, you must damage or derange something. The guidelines say, “Here’s the key derangements to the spine, here’s the guidance for providers to assess them, and here’s how to determine the effect they will have on a patient’s long-term future.”

These guides can cause confusion.

The AMA Guides are impairment guides, they’re body derangement guides. They take any derangement and determine what negative effect it will have on a person’s activities of daily living outside of work.

Now, if that impairment also causes the inability for that person to work or has diminished this ability in some way, the condition itself is a disability.

So, disability is how an impairment affects a person’s ability to earn a living and straight impairment is how the condition affects the person’s activities of daily living.

Everybody wants something that is objective.

The employer, insurer, lawyer, and the patient all want a fair and objective process. Objective in this case, simply means that it can be easily verified. Any reasonable person can look up a condition and find the reference information in these guides. These guides can be cited and used to deliver the consensus of the medical field on any injury or condition.

This makes them one of the easiest things to use in the world. SmartInjuryDoctors® definitely use them. They use them because it’s the only objective way to determine if you have a permanent condition. These guides are so easy to use and straight forward, that you can essentially have a permanent impairment evaluation on day one.

Don’t let this confuse you. An impairment rating is done at the end of care. What were talking about is an impairment determination, and that is what you are doing in your examination and procedures. Procedures such as an MRI, CAT scan, or standard x-rays. You’re using these procedures to find derangement in body parts.

The effect they have on a person is called an impairment rating. And that is done at the point of maximum medical improvement. This is the state where you feel as a doctor that the patient is no longer progressing or improving as a result of treatment.

The bottom line, every doctor in the injury market should be using the AMA Permanent Impairment Guides.

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Is Colossus Important in Understanding Injury Work?

Is Colossus Important in Understanding Injury Work?

by | Jul 31, 2019 | Articles

Is Colossus Important in Understanding Injury Work?

Attorneys, doctors, and anyone else in the injury market itself is finding themselves running into Colossus. So first of all, let’s define what is meant when we say, “Colossus.”

Colossus is the blanket term for evaluation software that the insurance industry uses to determine benefits. It is also used to evaluate the severity, significance, and how benefits are determined for a patient.

So, Colossus is the software an insurance adjuster uses to determine benefits at the end of care. It can also be used in conjunction with other software to figure out what should be paid on injury claims.

Colossus can be really, really simple if you understand it. The injury market has done it’s best to make it far more complicated than it needs to be.

Colossus is very logical software

There are experts in the injury market who claim that you shouldn’t know anything about Colossus, that it’s all just a bunch of garbage.

On the other side, there are providers screaming, “Colossus is everything. It’s significant, so significant to anyone dealing with injured patients.”

So, who’s right?

Colossus is very logical software and here’s what we mean by that.

Let’s take an example using a doctor, since we’re all doctors here.

Imagine if the United States decided today that all doctors could no longer get business insurance for injuries. So, if a patient were to fall on your property, even right out in front of your office and right into some nice soft grass, if they injured themselves, you would be 100% responsible for those injuries.

So, lo and behold you glance outside, and a patient actually falls. You hustle outside, and it looks like they fell into that nice soft grass, so you think there’s no problem at all. After all, they got up like there was no problem.

Now, eight months later they come back to you and say, “Look doc, I need a check for $96,000.”

And you say, “For What?”

“Well, for the injuries I sustained on the day I fell on your lawn.”

Now you’re left speechless, and you’re thinking, “Let’s slow down, and go through this step by step.”

This is exactly how Colossus looks at the situation.

Your first question is going to be the same one Colossus asks.

The first question is simply, what was the injury?

This is the diagnosis. They are also known as ICD-9 or ICD-10 codes. You may see them referred to as injury codes. So, you use the diagnosis to code the injury.

Is the injury permanent?

That’s the second question that Colossus or you would need to determine. And, you would also want to know that if the injury was permanent, how was this determination made?

Today, we have things called permanent impairment, that’s the basis for permanent injury.

So, with $96,000 on the line, we need to explain it a little further.

With a permanent injury, you’d want to know, and Colossus wants to know, how are you going to substantiate this finding?

What made it permanent? What objective evidence do you have that an injury occurred in the first place?

Next, we would want to know if this permanent injury prevented the person from doing something they used to do in the future. That’s known as “loss of enjoyment of life.”

When a person can no longer do something as a result of an injury, it’s called loss of enjoyment of life or a disability.

Do not confuse this with a disability in the workplace. That is something else. Workplace disability speaks more to the inability due to injury of a person to earn a living.

We would also want to determine if there are things that the person does that now causes them pain as a result of the injury they sustained. Is the person chronically in pain as a result of having to perform these activities. Those are known as duties under duress factors. So, we would want to know that.

Now, if we have an injured person, who has some sort of duties under duress for loss of enjoyment of life, they may also require ongoing care. That care is labeled as future medical expenses.

Let’s break it down into logical steps:

1.      We need to know what doctor the injured person saw. What they decided the diagnosis was and where the injuries were on the person.

2.      We would need to know if the injuries were permanent, and how this was established.

3.      We also need to know how this was substantiated and documented.

That’s how Colossus works.

As doctors, we need to go through the same logical process as Colossus. Now, there are other things but simply put this is the essence of the software and the process you need to be following.

There’re five major things that all injury claims require:

1.      Diagnosis of the injury.

2.      Establishment of permanency.

3.      How does this injury interfere with their daily lives?

4.      How does this injury alter their future plans?

5.      Determination of the need for ongoing care.

Now, in practice it’s a little more complicated than what I just explained, but if the doctors in the spinal injury market would just nail down those five things, it would be a whole lot easier. It would be easier on everyone involved in a claim, from the patients, to the attorneys, and to the insurers. If we handle this and document it properly, we cut down massively on the hassles involved with injury claims.

Everyone in the injury market should understand how claims and injuries are assessed.

We do have some common misunderstanding in the injury market. Let me give you an example.

One of the biggest things attorneys misunderstand is that there are guidelines for worker’s comp in their state and then there are separate guidelines for everything else. The worker’s comp guideline may state that you use the third edition of the impairment guides, that does not mean that, that’s what’s used with auto accident injuries.

The more standardized we can make the process, the more misunderstandings we can eliminate from the injury market.

We are starting to see this routinely happening in the U.S. by what we call the SmartInjuryDoctor®. These doctors train to serve the spinal injury market effectively. They are not trained to increase or inflate benefit claims. They’re actually trained to serve the market efficiently and reduce a patient’s need for future benefits by getting extremely good results.

Colossus is a logical process. Injury workups can be a logical process. When you understand both, it’s amazingly easy to provide what everyone associated with the injury market needs.

Patients need an accurate diagnosis and great treatment results, attorneys need incredible and simple to understand documentation, and insurance companies need the same thing too.

When an injury doctor provides this, everyone in the market wins. The adversarial environment reduces itself and that’s what the SmartInjuryDoctor® produces daily.

No doctor in the injury market needs to know everything about Colossus, but a basic understanding can improve your documentation. This shouldn’t be hard if you follow a logical process using common sense to know what the software is really needing to process a claim.

For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.comor check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

Want to learn more about Smartinjurydoctor's Program?

Learn more about dr. cronk

Reach Us

Want to know more? We are happy to receive a message from you.

246 Tierney Drive, Suite 1,
New Richmond, WI 54017

1-800-940-6513, ext 700

[email protected]

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Smart Injury Doctors
701 Richards Ave
Clearwater Florida 33755

[email protected]
Call Lee Ann at 1-800-940-6513, ext 700

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ICA Best Practice X-Ray Guidelines Discussed

ICA Best Practice X-Ray Guidelines Discussed

by | Jul 19, 2019 | Articles

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. For more information on Spinal Ligament Injuries please check us out at www.smartinjurydoctor.com or check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher. For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com

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