Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 870
Clinical Information 203 CI

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues are small, yet each issue is just that… an issue. If you take care of the small issues, then the larger issues often take care of themselves and you can focus on the larger issues… a larger, more profitable practice and more family time.

“Proper Flexion-Extension Positioning”

“First identify, then act” Mark Studin 2017
From:  Ray Wiegand DC

AOMSI is a measure of the DIFFERENCE in range of motion between motion segments. If either the flexion or extension views are not at or near full range of motion, it is unlikely that AOMSI can be detected. Frequently I receive lumbar flexion x-rays where little of no lumbar flexion occurred. The attached x-ray is an example of slight HIP flexion not lumbar flexion.

The patient should be instructed to try and touch the floor. If they are apprehensive, have them sit on a chair or stool and instruct them to touch the floor.  The Guides does not comment on taking the x-ray, standing or sitting or 40" vs 72". My assumption is that the x-ray is taken at 40" and standing. The FFD has no effect on rotational measurements, it may have a slight difference for translation.

It is better to have a more complete flexion view and something to measure than to worry about the standing or sitting position. Attached is an x-ray that was submitted as a lumbar flexion view. However, there is only mild HIP flexion and almost no lumbar flexion. When digitized and measured, there is insufficient segmental range of motion to detect AOMSI. 

I haven't seen x-rays from many of you. Statistics suggest about 70% of your patients have ligament laxity. This is first a clinical finding that should impact your case management. Second it may be a medical-legal issue for which documentation is necessary.  Don't short change your patient by not getting the diagnostics they need. It only comes back to haunt them down the road. 

Should you have more questions about this topic, please call Dr. Ray Wiegand directly: 636-329-8774. He is very happy to chat with you!!!



Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences

Academy of Chiropractic
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