Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 5

From the Desk of Dr. Mark Studin
Academy of Chiropractic
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.

"Soft Tissue Injury"

A doctor in Minnesota asked a very good question in response to an insurance company denial. I wanted to share the answer with you as this is a very common tactic based on an un-truth.
Should soft tissue injuries heal in 6 weeks, as per the insurance company?
First off....soft tissue injuries do not heal. That is physiologically impossible. They wound repair with internal scar tissue called adhesions. Adhesions are permanent re-arrangements of tissue and therefore, the joint will move aberrantly forever. Even a disc, which is a ligament, as it connects bone to bone, will wound repair and leave adhesions in the annulus, therefore interrupting the outer 1/3 of the annular fibers, irritating the recurrent meningeal nerve, causing discogenic pain, regardless of neurological compression.
It is true that soft tissue injuries stabilize within 6 weeks. However, if they have stabilized in an aberrant position, which is the case in virtually all trauma victims, it then takes months to get the joint to shift and then re-stabilize in the correct position. If not, then the joint will prematurely degenerate and cause further loss of function of the joint.
If it were true that soft tissue injuries resolved in 6 weeks, then every football player with a blown out knee would be back on the field, yet in spite of multi-million dollar contracts, they are out for at least 6-12 months with intensive rehabilitation.
As a side note, this is a good part of what I teach the lawyers when I lecture. It is also why I want defense lawyers and judges in the audience, so that when arguing these issues, it is about the physiological truth and not rhetoric. As a result, the patients win. It also gets the lawyers in attendance to understand that the doctors in the room sponsoring the meeting will have in their narrative the documentation to refute this argument and have a better opportunity to prevail in their cases based upon fact.
When communicating with the legal community, should this issue arise, let them know that you have handled this problem in your narrative through initial and final range of motion. That is the modality to objectively assess the functioning of the joint once you have identified the specific tissue that has been damaged through your diagnostic testing, as it clinically correlates to your physical examination. This is a very common problem for both the lawyer and the doctor.
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