Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1115
Lawyers and Medical 69 L
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006
"An Entirely New System to Get MD's"
Dr Studin: What are we talking about?
Guest Doctor: So when I'm asking a question on first 10 years of my practice, I did structural correction and then I moved away from it and now that I'm going back in and learning the spinal biomechanics with what you are teaching, I no longer do pre and post x-rays. And I'm wondering if that's something in order to really help patients that I need to resurrect and start doing.
Dr Studin: this is a really big multifactorial answer. And the fact that you've dumped that upon you understand structural corrections and that supports, the argument and this is something even Dr Rolland's and I talk about another people and we're talking about the future of our profession in the future of patients and what's working and what's not. I have a little more advantage than you and most only because I'm older and I've been around longer and I've seen a lot. But when I practiced, I x-rayed every patient. Every patient is what? 16 years or older, with not fear of X-ray, and understanding that there really is not a whole lot of radiation. I got rare screens, I mean really crazy rare screens and a minuscule amount of radiation. But when the whole choose wisely program came about, I really looked into the literature and the research and spoke to radiologists from Harvard and Yale. And the answer is that there has never ever been in the history of recorded literature any patients that have any negative helps to quell that from a diagnostic x-ray. We're not talking cat scans, we're not talking serial exercise just from two or three flashlights. There's never been anything recorded. It's to the point we're in Harvard The radiologists don't even wear a lead aprons anymore when doing x-rays for Uroscopy because they know it's absurd you get more radiation sitting out in the sun. But with that being said, the reason I took x-rays initially is because I needed the listing two times PIEX Atlas Left access, right, which way the spine is going. And I didn't do Pettibone but I did applied spinal by mechanical engineering. What's Ryan and I are going for years and I knew that if I took the patient in a lateral bend, I'm looking for biomechanics by their vertebra, not moving in a prescribed manner, and that actually gave me your blueprint. So the real question, is what are your goals? You can get a pretty good three-dimensional understanding of the spine globally by doing leg length check, static palpation, emotion palpation. But for me, I want a segmental analysis of what's going on. And then I want to look at the actual segments to determine when we do that through some Vectra, the x-ray digitizing stuff, And it tells me where the primary lesion is and there's nothing else in the world that can tell you that without looking at an X-ray, And then you have to digitize it and then you want to look at how many standards of deviation that's gone. Is it within the normal care physiological limit of the Vertebra? I don't care if the pains in their low back and you understand this as well as anyone. It could become the the primary lesion could be from their neck and when will you understand the mechanism of subluxation or the neuro biomechanical lesion, but when we understand that mechanism, we know that there's central sensitization. It goes up to the brain motor cortex and the brain then sends the muscles to spasm of disparate areas to compensate for that primary lesion. Just the spine has to be organized in a certain manner, so whether you take x-rays or not, you have to determine will that x-ray change your diagnosis, prognosis and treatment plan? If the answer is no, then what are you taking the X-ray for? But if you need that X-ray to be able to conclude an accurate diagnosis, prognosis and treatment plan, we know there's no negative sequela, then that tells you where to adjust your patient and if that's how you choose to practice, that's great. If not, that's fine also, but you have to have your own specific goals other than pain because pain Don't cut it other than pain What you want to do and remember, pain is the last to come and the first to go. You cannot make any spinal corrections as long as there's pain. Spinal correction starts when the pain is gone. I guess the muscle spasms have resolved. Did I answer your question?
Guest Doctor: yes, you actually did. I never thought about it. Just the way that you stated it. An accurate diagnosis, accurate prognosis and accurate treatment plan. I agree with you that you can get a lot from getting a three dimensional analysis and that's kind of what I've ended up reverting to over the last decade, but now I keep getting x-rays back on. My patients will be them trauma or let's say that they've got the icky spine. So they come in west, their x-rays from their primary care on. So grateful that I have them and I'm not changing but I'm not measuring the curves and I know how to put them back in, that's not been the focus of my treatment over the last few years. And I'm starting to second guess. Corrections don't take my clinic.
Dr Studin: Don't be a curve fixer, because sometimes that curve is compensation.
Guest Doctor: Yeah. That was one of the reasons why I kind of ended up falling away from doing a lot of the Pettibone work. Cause there were times where if I just listened to the patient's body, they were getting better and I couldn't figure out when it was working good or wasn't. And it is a clunky treatment approach.
Dr Studin: the true answer, the segmental, it gets segmental, you'll see what is within the spine organizes itself and compensation. So if you have something out of that organizational pattern, that's a primary lesion and it's a mess and you have to fix that one segment. Unless you fix that, everything can organize around it and the curves will take care of themselves. Get out of it better For increase as a form of compensation. Remember Wolff's law, if you have a segment of vertebra that's out of position for a period of time, the bones are going to remodel. So now the body has to curve. The spine has to curve around that remodeled Vertebra, the credit homeostasis. You've got a plum AP and lateral and those curves might be plumped. I took one of the doctors, and one of our very chiropractic mechanical theories and teaching it for years, and he says, well, if you do this and you use this instrument, you're going to create that curve to come back. My question is, what if that ever occurred? Was compensation the normal? what do you do? that's not for this conversation, Was his answer, We're not curve fixes. Individual Motor units will tell you where the problem is, but you need an analytical tool, which is why we created Symetra, which is a takeoff of Dr Weekend's work. So, but that gives you your answers and there's no guessing. There's no, let me get a three-dimensional clinical evaluation. I would suggest to the world, it's better than what a neurosurgeon would do, but it certainly doesn't hold a candle to those who actually look and measure where the primary lesion is.
Guest Doctor: So let me repeat this back to you real quick. I think I understand that if you're a curb chaser and all you're focusing on at that, is fine. It's a wild goose chase because what we're seeing there oftentimes is an adaptive response.
Dr Studin: I want you to call Dr. Owens and ask him to give you a demo on the Symvetra program. it's ready for prime time for AOMs PSI stuff. It's almost ready for prime time for full spine segmental analysis.