The ‘Miss Correct Posture’ competition. Contestants pose with trophies and their X-rays at the Chicago Chiropractors convention, May 1956.
As chiropractors, when we examine our patients ‘alignment’ we see mechanical disorders that might seem best quantified through the taking of an X-ray. Poor posture is plain to see, and it would seem logical that any physical distortion should be corrected by mechanical means, an adjustment. It is presumed that if such ‘alignment’ issues were to go undiagnosed; degeneratve changes, wearing, compression, pinching, stretching, distortion, thinning, weakening, atrophy, that the consquences could be quite profound.
Unfortunately, modern spine science just doesn’t support such a model.
The focus has remained on static, mechanical distortion of neural tissue i.e. impinged nerves, cord tension, changes to CSF flow, IVF ligament encroachment etc. That spinal disorders must somehow begin as a mechanical problem that then compromises the nervous system. In other words, something goes ‘wrong’ within the spine and this ultimately ’causes’ neurological disturbances.
Pain science now suggests that we may have this sequence the wrong way around
We need to change our thinking away from diagnosing and assessing alignment and posture through static imaging, but rather postural integrity, balance and spinal segmental control through dynamic movement.
You can have degenerative changes on your spinal x-ray and still have great range of motion and no pain, or you may have a lot of pain and poor range of motion.
Movement and function are dynamic, not static, and we are more accurately able to determine the functional deconditioning that creates vulnerable tissues for future injury, such as a disc bulge or joint strain.
What this means is that the painful tissue or symptoms that we experience in the spine is the result of a neurological system that has already begun to fail. And this failure is not evident on X-ray, or CT or even a MRI scan.
Chiropractors are dealing with deficits in which the way the brain ‘sees’ the body. In essence, a disconnect between their brain’s perception of their spine and the reality of their moving parts. This is a much more complex system than the simple ‘bone out of place’ or ‘pinched nerve’.
Although findings on X-ray can contribute to the patients pain symptoms, we need to evaluate the whole person, rather than treating the results we find on x-ray as the definitive source of that patients pain. We now know through research that pain is an output from the brain, an emotional response to perceived threat, rather than an input from damaged tissues.
As a practitioner I will get more valuable information about your presenting condition by assessing the way you move, your strength, understanding the physicality of your job/sporting requirments, identifying and removing stressful stimulus, understanding your perception of your injury and your expectation of how you think I can help you, not looking at a piece of film.
Chiropractor – Dr Shae Famularo
