I’m a Chiropractor, so I’m going to share my experiences as a Chiropractor, however, for all the non-Chiro’s you may find parallels with your profession.
When I meet a patient for the first time my sole objective is to work out their ‘unlock code’, the highest common denominator, the root…
Let me explain.
Your patient presents with cervicothoracic pain, mid thoracic pain, and lumbago. They feel that their neck pain is the worst, and each region has presented at different times with differing intensities.
As a Chiropractor you know symptoms are misleading and your first challenge is explaining this to your patient.
I’m a big fan of spinal x-rays and subscribe to the Gonstead analysis system. Aside from obvious exceptions, e.g. pregnancy, kids, cancer patients etc. I like to x-ray the majority of my patients.
I recommend you visit your local radiology center and get in front of the radiographers and radiologists. It is invaluable to you and them, to explain why you take full spines, the importance of weight bearing, and exactly what you’re looking for. Essentially you are training them to take x-rays exactly as you would if you had a machine in-house.
Over 20 years in practice, I have seen hundreds to thousands of spinal x-rays.
In my view this has always been clinically justifiable.
Congenital anomalies, spondylolisthesis’s, pons ponticus; teenage scoliosis; disc degeneration, hip cam lesions, femoral head cysts, extra ribs…the list goes on. All of these incidental findings are critical in my working diagnosis and treatment process.
In addition, I’m able to see my patient’s biomechanical spine-pelvic pattern or what I call ‘blueprint’. I can evaluate primary vs secondary biomechanical regions and start to see where the root problem may lie.
Of course the x-rays are still positional so may not be exactly accurate, however, in my experience, the clinical correlation is accurate.
X-rays are gross in so far as you need 30-50% of change before it becomes evident on a film. For this reason, I review films 8-10yrs unless the patient has had a significant trauma, e.g. MVA.
So let’s revisit your patient. X-rays reveal an angulation at T4, elevated right hip, elevated left inferior scapula angle and shoulder, tilted right occiput. A parallel at the mid thoracic region tells me T4 is the primary irrespective of the patient’s pain. The pain above and below is due to compensations.
This is the unlock code and in my experience remains consistent for quite some years. What changes is the way the patient manages this pattern. Adjustments become easier, further apart, less or no pain etc. however, the pattern remains.
There is some controversy in our profession around justification of spinal x-rays. I believe one spinal x-ray every 8-10 years is justified. I have never yet, found one to be useless.
About the Author:
Dr. Andrew Arnold (Chiropractor) is the ‘Practice Leverage Expert’; Principal Chiropractor and owner, Cranbourne Family Chiropractic and Wellness Centre; Accredited Business Coach; Founder, Million Dollar Wellness Practice. Andrew is married to Dr. Linda Wilson, the Stress Specialist and has two children, Isaac and Bella. He lives in Melbourne, Australia.