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Three Simple Tips for Getting Better Spinal Injury Recoveries

Three Simple Tips for Getting Better Spinal Injury Recoveries

Three Simple Tips for Getting Better Spinal Injury Recoveries

Injury recovery, especially in the spinal ligament injury market is significant because 50% of the patients that received this type of injury will not fully recover, and 30% of them will have a significant amount of problems associated with that type of an injury.

These injuries are not the sexiest injuries in the market, but they are the most common injuries in the market. They cost the most amount of money. They cause the largest amount of personal trauma and trials and tribulations simply because so many people with these types of injuries result in a chronic outcome.  As a matter of fact, if we have 4 million auto accidents or auto injuries in this country, 2 million people every year are going to become chronic as a result of those injuries.

When you are dealing with patients, you want to get the best results.  I’m not going to get into specifics of adjusting for chiropractors or type of modality you’re going to use or anything similar. I’m going to start with some very, very general tips for you. In a Smart Injury Doctor’s Program, we call these Smart Injury Recommendations and they’re just some very, very general recommendations.

We know that when a person has a spinal ligament injury, they need to take this injury quite seriously. Your approach to that patient, your level of professionalism, your level of certainty, your level of handling the patient, will guide their response to their injury and compliance in their care.

Spinal ligament injury conditions can cause them problems. It is a fairly permanent condition. It can cause an unstable segment or segments for a long time to come. The patient needs to take their initial treatment very seriously because that’s where you’re going to try to reduce down their risks for long term residual complaints and get them a great, great result.

One of the first things that you should be discuss is dehydration. When your body is not receiving the amount of fluids and the amount of water that it needs, it takes a toll on injury recovery. It slows it down, making recovery not as swift. Remember, water is the primary way that oxygen and nutrients get delivered directly to a spinal injury. Dehydration is one of the most common reasons why cell function becomes disrupted, no matter what. Essentially if you lack fluids, you’re going to create a delay in recovery and less optimal result of recovery.

Typically the body fluctuates from anywhere to 60% of its total weight is actually water. So how much water do you want the person to consume? About half their body weight in ounces of water every single day. They will improve their injury results if they are hydrated.  If they drink coffee, they need  to offset that cup of coffee with an extra cup of water. You want them drinking water. It’s a very general recommendation that basically hits home. Hydration.

The next Smart Injury Recommendations is proper sleep. Sleep is so misunderstood. But if we look at the course of injuries and how injuries heal successfully, they have to have healthy tissue growth. They have to repair the damaged tissue and now have healthy tissue growth. According to the National Sleep Foundation, growth and repair of tissue occurs in the third and fourth stages of sleep, which after you’ve completed about 70% of your rest, that’s when those stages happen. This means that your patient needs  to get an uninterrupted night of sleep. It’s crucial.

So what’s enough sleep? According to Mayo Clinic, the optimum sleep for adults is 7 to 9 to hours. A teenager, needs 8 to 10 hours. That’s what required in order for optimal healing to occur. Optimal healing and the repair of tissue occurs in the later stages of sleep.

The third recommendation that our doctors recommend, is they need to eat a healthy diet. You want them to consume a good non-inflammatory diet. One that is reduces inflammation. Consuming more anti-inflammatory fats. These fats are fish, salmon, sardines, olive oil mix and nuts and seeds, avocados, flaxseed oil, fish oil. Staying away from processed foods that are high in saturated fats. Vegetable oils, like corn, safflower, sunflower, soybean oils, or foods with trans fats. Those are high inflammatory foods.  Also include anything that is a leafy green vegetables, highly anti-inflammatory. Anything that’s a vegetable that’s grown above the ground is highly anti-inflammatory.

There are also some spices that are anti-inflammatory, like bromelain from pineapple, garlic, curcumin, turmeric, curry powder, cocoa, tea and berries. They provide anti-inflammatory substance and they also provide a lot of nutrients. They’re nutrient dense, and that’s what the body needs when it’s going to repair.

You don’t just recommend these three, you follow up by asking about it in your re-examinations. Especially if you have a patient that’s not progressing in a manner that you deem to be appropriate for what you normally see under your care.

It is easy to just talk to the patient about better sleep, better hydration, and better diet at least while they are going through your treatment program. If they adopt these habits, you’ve created a healthier patient. You’ve created a much healthier patient. That’s one of the things that as you as an injury provider can significantly help and influence a person to become healthier and now they can also look at long term things that keep their health such as ongoing care, supportive care in your clinic.

All of us have a spine. A spine is like the teeth, if you don’t maintain it, you’re not going to get as much mileage out of it. People should take their spinal health very seriously and you as an injury provider can seriously influence that.

Three simple recommendations.

Hydration

Enough Sleep

Anti-Inflammatory Diet

 

In the Smart Injury Doctors Program, we call these Smart Injury Recommendations. There’s other recommendations that you can give the patient to get better outcomes, but these are three simple things that you want to go over with the patient that will improve your injury results.

 

https://www.smartinjurydoctors.com/
https://www.thespinalkinetics.com

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Why Don’t Chiropractic Colleges Teach Standard Injury Workup?

Why Don’t Chiropractic Colleges Teach Standard Injury Workup?

Why Don’t Chiropractic Colleges Teach Standard Injury Workup?

My question is why don’t chiropractic schools in this country actually teach their students how to do a standard spinal injury evaluation?  This topic may seem a little bit controversial, but it needs to be addressed.

It not just chiropractic colleges who are remiss, it is also missing in osteopathic colleges and medical colleges. But since chiropractors are the spine specialists and trauma to the spine is the number one cause of chronic pain and disability, the market needs experts in this particular area. So why in the world would the chiropractic colleges not teach standard spinal injury assessments?

Doctors of Chiropractic are not taught how to determine the severity and location of a simple ligament injury.  They are not being taught about the fact that there are two ways to image a ligament injury, depending on what ligament is damaged.

If you have a disc herniation, you’re going to use obviously an MRI. But the fact is, there are 220 specialized ligaments that hold the spine together.

If you have damage to the supporting ligaments around the disc, shear force injuries, they cause excessive motion in the spine. That excessive motion of the spine is how you determine the severity and location of the actual ligament injuries.

If you have a C4/C5 motion unit and you have severe excessive 3.9 millimeters of translation back and forth movement, due to the supporting ligaments now being damaged due to the trauma. And at four and five we know that the fifth cervical nerve exits, we know that that would cause a possible motor problem. We would have possibly a deltoid muscle weakness. We would have the lateral side of the arm, either hyper or hypo sensitive. We want to check that dermatome so we know where the C5 dermatome is. If we knew what muscles are involved and we can test for the particular level.

For an examination procedure, we have a hypersensitivity or a hypo sensitivity at the C5 dermatome and we have a C5 muscle that’s testing weak, then we should immediately want to know, what’s the C4/C5 motion unit like? That’s the main motion unit. Could be the one above or the one below that as well. But is that damaged?

If it’s damaged, the ligaments are damaged and you’re going to see excessive motion. If there’s excessive motion, how much excessive motion is there? Is it mild, moderate or severe?

Because if we have excessive motion that causes a motor sensory or pain problem, we have in the old terms clinically a chiropractic subluxation, which means misalignment or misalignment pattern. The mismotion pattern that causes a nerve condition.

It’s also called a spinal instability in medicine, meaning excessive motion that now causes a motor sensory or pain problem.


And it’s the easiest thing in the world to do a workup on. It’s the easiest thing to image and it’s the easiest thing to standardize in injury practices across the country. But it’s not being done.

The fact is that 90% of the patients out there are in chronic pain, do not have a pathoanatomic cause.

We have experts like William Maurice, the head of the Ohio State Biodynamics Laboratory who is a leading researcher in spinal biomechanics and spinal pressures in the world. His book is called The Working Back System where he’s trying to help solve the problem of low back lumbar spine.  This is the number one cause of disability, lumbar injuries, cervical injuries are the number four and cervical injuries also lead to the number six leading cause of chronic pain and disability, which are headaches.

He cites eight out of nine, or 90% of the patients who have a low back disability, do not have an exact path though anatomic caused identified by doctors that basically are treating the patient, creating a huge expense for employers and Workers Comp., for example

One of the things that is needed in the market itself is the simple understanding of how to determine the severity and location of these ligament injuries that are so expensive to the employers. Employers should be demanding it.  

If I’m going to use a Doctor of Chiropractic, they need to know how to do a standard examination for these types of injuries.

If I’m going to use a medical doctor, or an osteopath, then they need to be able to understand, and standardly work up these injuries, because it’s the misdiagnosis or the the lack of diagnosis, that creates an environment of substandard.  

Remember, if you’re going to change something, you must get down to the cause of what it is before you’re going to get great results in changing it.

If you don’t know what the injuries are and you were not taught to standardly workup an injury, you were not taught how to determine the severity and location of a simple ligament injury.

It is not and never has been just writing a cervical sprain down on a diagnosis code.

For somebody today to say, “Well, this patient has a cervical or lumbar sprain and that’s their diagnosis.” That’s like somebody having a leg injury and having the doctor say they have a lower extremity sprain.

The first thing anybody should be asking is, “Well, where is the sprain? Where is the ligament injury? How bad is it and where is it?”

If have you had a leg sprain, you’d say, “Well, where in the leg?”

In the knee, how bad is it? Well, it’s a grade three sprain. It’s a grade three ligament problem.

This is how I identified it. This is how we imaged it. This is what we’re doing to treat it.

It is the first step to great injury results. I don’t care if you’re an employer,  a patient, or a doctor,  the first thing that has to occur in order for you to get good results is you have to identify the severity and location of the injuries.

And we have to be able to do that standardly.

Right now there are 60,000, 80,000, 90,000 chiropractors out there, my colleagues, none were trained in a one year, six month program and how to determine the severity and location of a simple ligament injury. That injury that causes the most amount of problems in the market today. So if you’re a student today at a chiropractic college, you should be asking your educators why they’re not teaching you that.

That would be like dentists coming out and not knowing how to locate the severity and location of dental decay. Of course when you go to dental school, you’re going to be able to determine the severity and location of, of dental decay of tooth decay. So why in the world would you be in a health market, in a health care educational program today, and not know how to determine the severity location of a spinal ligament injury?


It just blows my mind that that’s occurring. It occurred for me, I graduated from Palmer College one of the oldest colleges in chiropractic in the country. I graduated in 1988 and I was never trained how to do it.

 I know to this day when I asked students that are coming out of all of the chiropractic colleges and just say, “Okay, simply tell me how to determine if a ligament is damaged in the spine.” Remember the spine is the main thing that Doctors of Chiropractic deal with.

If ligament damage is the number one cause of pain and disability in the world today, how do you determine the severity and location of a patient that’s just injured their ligaments? How do you know where it is and how bad it is?

If you don’t know where and how bad, how are you going to get successful results with it? If you’re getting some successful results with it, think about how much more successful you could be if you knew the severity and location of the condition.

If all doctors were trained in it, that would change the environment in the United States.

Chiropractic, my profession is very small. When groups do research, the research of the markets about a $14 to $15 billion market. It’s a very small market. It’s like a third of 1% of the total healthcare dollars spent are spent in the profession of chiropractic.

It is very, very small. It represents less than a third of 1% of the total healthcare dollars spent. That is 14-15 billion in medicine, back problems, low back problems in 2010 we approximately $253 billion.

Medical doctors in the market today, weren’t trained either on how to determine the severity and location of a simple ligament injury. It is not occurring in the medical market either. And it needs to be occurring with every doctor.

Because the more that you understand, you will be able to accurately and swiftly know the diagnosis. Leading to the use of conservative care procedures that are highly successful for this type condition. Lessening or eliminating patients suffering from long term chronic problems that could have been prevented.


Chronic pain and problems are devastating to injury patients emotionally and financially.

It hinders their ability to work, it hinders their ability to be successful in their family, and to participate in normal activities of daily living.  

It doesn’t have to be that way. We have to get much better. We have to become Smart Injury Doctors and use accurate and objective testing for ligament injuries and diagnosis and treat quickly and with confidence.


Remember, you can’t misalign a spine. You cannot have a hyperlordotic cervical spine or reverse cervical curve, a PLRC5, without ligament damage. Therefore, you must understand about ligament damage

If you’re going to be trading in these things, particularly in the injury market, if you haven’t learned how to determine the severity and location of a simple ligament injury, that is what the Smart Injury Doctors program is for. You go to www.Smartinjurydoctor.com and you become a specialist.

We’re creating a group of doctors, chiropractic doctors, medical doctors, and osteopaths, that fully understand the urgent need for accurate objective testing and swift and accurate diagnosis.

Come in and learn about ligament injuries. We are the leading group of injury specialist.  It is where we are training doctors to have that level of understanding.

You should have been educated in this deep understanding in your basic training, so should’ve I, but unfortunately,  it’s not there.

We must get it outside of our formal education.

Become a Smart Injury Doctor and lead the way into the future of injury care.

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The Three Skill Sets You Must Have to Build a Successful PI Practice Today

The Three Skill Sets You Must Have to Build a Successful PI Practice Today

What are the three things as an injury practice business owner do you need to do exceptionally well in order to truly expand in the injury market and do it so that it’s easy? So that it’s not so stressful?

There are three basic skill sets that you must have. I’m going to lay those skill sets out today. They’re very simple.

The first skill set is that you, as a clinician, must be extremely good at what you do. You must be able to do a few things well.

  • You must be able to diagnose all of the injuries that the patient has. And you can’t miss injuries and simple ligament injuries. You must understand that there is a disc herniation and then there is excessive motion. You must understand picking up both findings so that you can determine easily the severity and location of any ligament injury that the patient has. You must be able to diagnose these things incredibly well.
  • Then you must be able to treat them incredibly well.  The first thing to treatment and treatment results is really having a sound understanding \ of what the underlying condition is that you are treating. The better you understand the underlying condition, the better your treatment results are going to be. You must be able to diagnose well, and you have to be able to treat well.

And today in the injury market, you’re in a medico-legal situation. You must document well.

  • Your documentation determines the benefits that the patient is going to be able to have access to and potentially get.
  • Your documentation determines whether the plaintiff attorney has a hard time or not.
  • Your documentation determines whether the defense attorney has a hard time or not.
  • Your documentation depends whether the insurer has a hard time or not.

You must be able to express yourself simply when in a deposition or a court trial setting.

  • You, as a doctor, must be able to diagnose all the injuries the patient has.
  • You must be able to get great treatment results with these conditions on a regular basis. And I mean great treatment results.

If a patient that goes through your treatment program, no matter how long it takes, they should not have chronic pain, any activities of daily living disorders, duties under duress, or loss of enjoyment of life factors.

If you can do this with a high degree of confidence and a high degree of predictability and routinely with patients, that’s step number one in your business because you are the person that produces the product and results of an injury clinic.

The second biggest thing that you must have is a well-trained team. Your team is super, super important and training your team is one of the highest returns on investment activities that you can actually do.

Everyone trains their staff, everyone trains the front desk staff how to answer the phone, the billing person how to code for bills, how to send out and make phone calls to insurance adjusters, and to follow up on denials. Everyone trains their staff to help your patient fill out the paperwork correctly ,how to route the patient to the room correctly, or how to schedule the patient correctly. Those are all routine things. That’s not what I’m talking about here. What I’m talking about now is the ability to train your staff to answer questions about the injury work that you do, as good or better than you do. When I say better, sometimes the staff are better because they’re simpler and they put things in layman’s terms much.

  • Your staff needs to understand what a patient is going through. They need to understand the reality of the patient, whether it’s day one, which is one of your most important visits.
  • What is that patient going through?
  • When they first get into your clinic, what is the experience that they’re going to go through? What’s the experience with the first phone call?
  • Routing them in, filling out your paperwork, gathering their insurance information,
  • Introducing you, the doctor in their first visit.
  • Your consultation, examination procedures,
  • Imaging procedures of you do them internally.
  • Treatment procedures.
  • Information that you provide them with to take home.
  • How they are rescheduled.

Every person in your staff needs to understand the high points of what needs to get communicated in each one of the visits.

  • If you or your staff do not understand, or  you don’t have a team around, you’re seriously cutting the number of referrals you can get;
  • you’re seriously cutting the amount of the reduction of problems that you would have with reimbursement;
  • You’re seriously cutting down the results that you can get with the patients as far as their physical results;
  • You are cutting down a lot of things that simply don’t need to be cut down.

Training your staff is one of the most important things you can do but training them specifically in what makes you unique as an injury provider is even more important. When patients leave the room and walk down the hall and suddenly have more questions, if they can’t go to anybody in your clinic and ask and get a great answer to the question, you’re seriously losing money, results, and causing yourself a lot unnecessary of stress. That’s simply because you haven’t trained your staff.

The doctor also must be able to market. Marketing is nothing more than determining how you want to be perceived in the market.

  • You must ask yourself how you want to be perceived in the market? You want to be perceived as the best doctor a patient can go to.
  • And what does that mean? It means that you are fast, effective, you don’t miss things, make the rehabilitation very easy and simple to understand, and you get great results.
  • You document so that anyone that the patient is involved with, from a plaintiff attorney, defense attorney, their insurance carriers, to their state work comp carriers, has a lot easier time with it.

That’s how you want to be perceived. I want to be perceived as somebody who doesn’t miss injuries. If I’m going out to attorneys, I want to be perceived as somebody who documents so incredibly well that it makes their life super, super easy. If I want to be looked at by insurers, I want to be looked at somebody that’s honest, ethical, and highly professional. That’s how I want to be looked at. That is called a marketing strategy. Deciding how you want to appear to your market.

A marketing plan is deciding how you want to get that perception out to your community. Advertising is where you put that message on paid or unpaid communication lines. A paid communication line might be a radio commercial or a TV commercial, or you might do some sort of a newspaper ad. You might be doing all kinds of social media posts. You might be sending newsletters out to your patients, past and present. You need to communicate to your patient base on a regular basis. That’s called marketing.

When you accomplish these three things, it becomes very easy to expand. It’s easy to put associates in behind you. It’s easy to bring in new, well trained staff and retrain staff. If you understand how you want to be perceived and you’re putting that perception in the market, you’ve got it made in the injury market. And the injury market, in my personal and my professional experience, is the most fun market to be involved in because it’s a very high purpose game.

Patients that are injured have a 50/50 chance of never fully recovering, so they need the best doctors to be treating them. And that’s what made that game super, super fun for me because I wanted to be that doctor.

I run a program called the SmartInjuryDoctors programs and that’s why doctors are attracted to the program because that’s what they want to be. Marketing does one really neat thing; it repels what you don’t want, and it attracts what you do want.

You must decide professionally what you want to be in, how you want to be perceived. Because once you make that decision and once you start going down to that path, you will attract what you want to attract. Right now, if you’re getting things that you don’t like, you need to look at how you’re being perceived and what you’re putting out because that’s what you’re attracting. I like to always work with high level people. That’s what I like to work with, and I think you will too.

The three components of your business are you, your staff, and marketing. They are key things to being able to grow your injury practice now and for the next decade or decades to come.

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?

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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

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CONTACT US

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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© 2019 Biocybernetics Inc.

The Five Steps to Great Spinal Injury Documentation

The Five Steps to Great Spinal Injury Documentation

The Five Steps to Great Spinal Injury Documentation

There is a lot of confusion about injury documentation. There are five general steps to injury documentation, and it is currently being made much more complicated than it needs to be. All injury documentation has these five basic steps in common and they are really very simple.

Step One:  You Have to Diagnose All of the Injuries

Whenever somebody is trying to adjudicate benefits for a patient, the first thing that they look for is the diagnosis. In other words, how injured is the patient? In a spinal soft tissue injury, there are two imaging biomarkers substantiate injury to the ligaments themselves.

The first is disc herniation. There are 220 specialized ligaments that hold the spine together. 23 of those ligaments are discs. The discs are evaluated generally on an MRI.

If any of the other 197 ligaments, including the disc are damaged, they can cause excessive motion to the spine. Excessive motion is one of the most significant problems that a patient can have. We must diagnose the ligament injuries thoroughly. We must diagnose what is wrong.

  • Did they fracture?
  • Do they have a disc herniation?
  • Do they have excessive motion?
  • Is it causing a spinal instability?
  • What is the grade and severity of the sprain?

That is all part of the complete diagnosis. And you need an accurate diagnosis.

Step Two: You Need to Document If the Condition is Permanent or Not

Any injury that is permanent has a section on t in the permanent impairment guides. Remember, impairment is a derangement of a body part. All injuries are derangement of body parts. The evaluation of permanent impairment that was done by the AMA could be called the guides to the evaluation of permanent injury because it is injuries that caused the derangements in the first place. You need to note whether there is permanency and that’s very easy to do. You  just use the AMA guides to determine if there is a permanency.

Step Three:  Duties Under Duress Factors?

If a patient can do something but it causes them discomfort, it is called a Duty Under Duress factor. They can ride their bicycle with a low back injury, but not like they could prior to the injury. For example, they previously were able to ride their bike for ten to twelve miles and now they are only able to ride it two miles before getting severe back pain. They can still do it, but it is causing problems when they do. These are called duties and under duress factors.

Step Four: Loss of Enjoyment of Life Factors

Let us look at that same back injury but the patient can no longer ride their bike because it is too physically painful. They must stop doing that particular activity because they are physically unable to.  These are called Loss of Enjoyment of Life Factors. These factors must be documented as well.

Step Five: Future Care Needs and General Progress Documentation

At the end of care, all doctors document reevaluation. If you’re doing any kind of a physical rehabilitation on a patient, you’re going to document outcome assessment procedures to show that you are basically gaining ground on the condition. It will show that what you are doing is actually working.

And then you also must document these five factors. All the injuries. Is their permanency, which means permanent impairment guides? Are there any duties under duress or loss of enjoyment of life factors? Now lastly, if let’s say that you’ve gone through your rehabilitation procedures and the patient’s gone through your program, whatever your program is, or you’ve sent patients out for various programs and at this point you’re at maximum medical improvement. Remember, maximum medical improvement is, I’m looking out at that patient. I’m looking out into the future the next year and no matter what I think this patient would do, their outcome is going to be the same. We’re at maximum medical improvement. Now, if a person has a permanent condition and they have a loss of enjoyment of life factor or duties of duress factor, then they also may be entitled to future care. They may need future care, supportive care, to maintain the results with their care. And in that case, it can be substantiated, but you must have all the other factors there as well.

You Help the Patient to Get Any and All Benefits That They May be Entitled to.

It is very, very easy today to document injuries, but you must be sure you have all five factors. Many doctors really struggle with one, the diagnosis, especially with ligament injuries. They don’t get a diagnosis of a severity and location of a ligament injury, and without that, the patient is going to have benefit problems. You are also missing out on permanency factors if it is not documented. Without that, there is no rationale for why they have lost the enjoyment of life of something or they have duties under duress factors. These five things must be documented clearly in doctor’s notes, on all injuries.

It doesn’t matter if it’s a work comp injury. Now some work comp providers will say, “Hey, in our work comp jurisdiction, we don’t use the AMA guides to determine disability.” Remember, impairment is how a physical injury influences a person’s activities of daily living. Disability is how it affects their ability to earn a living. In the ‘earn a living’ work comp area, they may say, “Hey, we don’t use the impairment guides for our disability.” A lot of times that confuses practitioners, but it is actually very simple. It just means that they use a modified approach. Everyone uses the impairment guides. No one is going to create new impairment guides to determine impairment. They just may have a modified system in their state that says, “Oh, we don’t use the impairment guides direct. We use a disability guide, which we’ve modified from the impairment guidelines.”

Systematize and Simplify

Injury practice and injury documentation is very easy if you’re systemizing and getting those five steps in place. If you are struggling with reimbursement issues or you’re struggling with doctor’s contesting your care, such as IMEs and utilization reviews, you must look at your documentation. In my experience, if those five elements are left out, and usually it starts with a diagnosis right from the foundation, there is no impairment, no duties under duress, or no loss of enjoyment of life factors. If they are there, they’re not documented properly.

And doctors, you know if you don’t document properly, then you don’t get paid properly and that’s not so much on you. That’s more on your patient. Your patient does not get the insurance benefits that they may be entitled to and it makes everyone’s job harder. It makes the insurance company’s job harder. It makes the plaintiff attorney’s job harder. It makes everyone’s job harder when you don’t document well.

In my experience with teaching, which I have done for doctors all over the country, these things are not being documented well. If you pick up those five things, you have seriously improved your documentation skills in the injury market, and everyone will benefit. You’ll benefit. Plaintiff attorneys will benefit. Defense attorneys will benefit. Insurers will benefit. And most importantly of all, your patients will benefit greatly.

For more information and tips on how to reduce the problems and stress associated today with growing a large and successful personal injury practice 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?

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

Leave A Message

CONTACT US

Smart Injury Doctors
701 Richards Ave
Clearwater Florida 33755

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

SEARCH THIS SITE

© 2019 Biocybernetics Inc.

WHAT IS A SPINAL INSTABILITY?

WHAT IS A SPINAL INSTABILITY?

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 which 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 an x-ray or on an 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 and 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 gaged 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 these three things:

  • Motor
  • Sensory
  • Visceral

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. Register for our next Webinar to discover more about diagnosing spinal ligament injuries.

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Medical Radiologists Can Provide Objective Impairment Findings

Medical Radiologists Can Provide Objective Impairment Findings

Medical Radiologists Can Provide Objective Impairment Findings

Computerized Radiographic Mensuration Analysis (CRMA) is a procedure that our Board Certified Medical Radiologists perform which brings motion analysis to static x-rays. Our Radiologists can now provide this motion analysis in order to accurately quantify Alteration of Motion Segment Integrity (AOMSI), AMA Permanent Impairment Guides 5th Edition Page 378-379. With CRMA technology these Specialized X-Rays (Called Dynamic Stress X-rays) reveal some of the most serious impairments found in spinal injuries today. For example in the cervical spine the CRMA is a process of measuring these injuries in two aspects, first in TRANSLATION (back and forth slippage) which should not exceed 3.5mm and second, ANGULATION (anterior wedging) which should not be greater than 11° that are being performed on neutral/flexion/extension standard X-Rays. Measurements exceeding these values are considered permanent injuries as establish by AMA and DRE table 15-5. CRMA procedure captures, measures and quantifies the intervertebral motion in stress x-rays that is due to ligament sub-failure injuries that produces a significant condition called ligament laxity (728.4). These often serious spinal injuries are detected as excessive translation and angulation patterns in the spinal motion units. The resultant spinal instabilities, can be permanent painful and progressive if left undiagnosed. CRMA procedures provided by trained professionals that are not involved in the treatment of the patient is a way that provides Unbiased, Objective, Accurate Quantification of these significant connective tissue injuries that are all too commonly missed. THIS OBJECTIVE QUANTIFICATION IS A KEY FACTOR IN SPINAL INJURY CASES. Spinal Ligament Damage: Ligament damage to the spine is demonstrated by abnormal translation and angular patterns of the spinal motion units. These serious injuries are accurately measured and then correlated directly to the AMA Guides for AOMSI, (AMA 5th Edition Page 378-379). These unbiased objective services provided by highly trained Board Certified Medical Radiologist’s can quantify these spinal ligament injuries in the 4th, 5th or 6th edition of the AMA Guides to the Evaluation of Permanent Impairment. No one needs to miss these serious findings any more. For more information regarding these services simply go to www.spinal-kinetics.com  
 

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

1-800-940-6513, ext 700

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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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© 2019 Biocybernetics Inc.