The #1 cause of chronic pain and disability in the world is spinal ligament injuries. Ligaments attach bones to each other. We have 220 spinal ligaments of which 23 are discs.
The prevailing thought for spinal injuries seems to be centered only on discs. An MRI is a disc study. It is taken in a neutral position in which no one ever maintains unless we are in a coma. We of course are dynamic creatures that move.
The gold standard for accessing spinal ligament injuries is functional radiographs, ie flexion/extension x-rays. The American Medical Association’s Guide to the Evaluation of Permanent Impairment gives the exact parameters for measuring these instabilities.
This is a measurable phenomenon that can not be “eyeballed”. Most radiologists will not take the time or put in the effort to measure for ligament instability. We have a special computer program that enables us to do this but it takes about 20 minutes. Radiologists are paid by the imaging read. The more they complete the more money they make.
These dynamic measurements allow us to identify the weak link in the spine that more often than not corresponds with the patients symptoms and exam. When we can match x-rays, exam, and symptoms we know we have diagnosed the cause of the problem.
A ratable injury is called AOMSI-Alteration Of Motion Segment Integrity. If this is found in the cervical spine it can be worth as much as 24% whole person impairment. This is equal to or greater than the 2 other injuries to the spine, fractures and disc herniations.
Most patients are amazed with the computerized spinal ligament analysis. They have never had someone explain the cause of their symptoms so precisely. I was also amazed about 10 years ago when I first discovered this analysis.
I have been in lecture halls full of chiropractors, that also had this epiphany. After 10 years in practice I learned the cause of most patients’ pain, and it is a gift from the AMA. This was transformational for my patient care.