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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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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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