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There are too few doctors that know how to properly diagnose Spinal Ligament Injuries.

November 7, 2017 by Dr. Mark Lesko0
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What is a diagnosis? Diagnosis is the identification of the nature of an illness or other problem by examination of the symptoms. The word nature here means a “phenomenon” of the physical world. Some this that is physically abnormal is now causing the symptom(s).

The nature of the condition or cause is what you always physically see with it. With Hepatitis C for example, there are things that always accompany it physically, such as Hepatitis C antibodies in your blood. These antibodies are the physical thing that is found to make the diagnosis. These antibodies in other words are the physical Biomarkers ( a physical, measurable, body phenomenon) that leads to the correct diagnosis. With moderate to severe spinal ligament injuries the one thing that you always see is physically is excessive joint motion. The joint moves to much and can be unstable and cause pain and the problems, or symptoms listed above. This is so easy to diagnose with a simple set of x-rays which I will explain more of in just a bit—but for now what happens to any condition that is not diagnosed properly?

An important study in the Agency for Healthcare Research and Quality finds that nearly 10% to 30% of all diagnoses in America are wrong. Although misdiagnosis is quoted to occur around 40% of the time – which is a huge number – I find that in my 25-plus years of experience, that it is at least twice that high when it comes to spinal ligament injuries.

So what happens with misdiagnosis…

Trisha Torrey, Patient Empowerment Specialist at AboutHealth.com, explains the following about misdiagnosis:

When a healthcare provider considers a patient’s symptoms of illness or injury, reviews the evidence, but arrives at the wrong conclusion about the name or source of that illness or injury, a misdiagnosis results…the wrong name is given to an illness or injury… the treatment recommendation could also be wrong, resulting in further illness or debilitation. The treatment the patient really needs, which would result from a correct diagnosis, is delayed, or never takes place.

So, what do you think? Isn’t is obvious that when a condition goes undiagnosed the patient suffers, in some cases permanently?

This is the biggest problem with spinal ligament injuries themselves and is the main reason they are the number one cause of pain and disability in the world today; too few doctors know how to properly diagnose them! This is VERY BAD for the patient as time as I mentioned earlier is critical here. The longer the ligament injury goes undiagnosed and untreated the higher the risk that the symptoms will never fully go away!

This is important to get as it is the biggest reason all those people around you that have chronic neck or back pain—have this pain in the first place. They did not get to the right doctor quickly enough! Here is chronic pain briefly. Most of you have been to a rock concert at some point in your life; wow what a pleasure moment! Now after this incredible event many of you had ringing in your ears. Why? Simple you were submitting your ears to noxious stimuli, in this case sound that can cause damage to the fine hair like nerves in your ears. The ringing was a sign that abnormal pressure was on those nerves. Now the key is you quickly got the problem relieved (left the concert after a short time – hours), and the abnormal pressure came off those nerves. What would happen if you were in that same rock concert for say 9 months? Now the damage may be permanent, or very difficult to get rid of. In other words, you may have ringing in your ears for the rest of your life—that is chronic pain in a nutshell.

Spinal ligament injuries are no different! The ligament is injured, swells, the swelling causes pressure on the nerve and the fight is now time. Can you find a doctor quickly that knows how to diagnose this accurately and then knows how to treat it (gets the pressure off quickly so that it has far less opportunity to become permanent)?

So, the question remains, how do you diagnose the spinal ligament injury?

Remember, spinal ligaments do two things: they hold the bones in perfect alignment through any activity so it can be performed without injury; and they coordinate all muscle activity via their mechanoreceptors’ communication. When mechanoreceptors get, damaged and go offline they provide the spinal muscles with corrupted communication, causing inappropriate muscle support, instability, and pain.

Knowing what a body part does means you can test to make sure it is doing it right. If spinal ligaments keep your spinal bones aligned during use, then you can x-ray those parts while you are using them to see if alignment is being maintained. From these images (x-rays) we can accurately measure your spinal alignment patterns and look for the excessive motion, which is the nature of this type of injury.

Remember what I said earlier, when a force suddenly overwhelms the spinal joints and forces them out of alignment, the ligaments are over-stretched or torn, leaving the joints looser or lax. The mechanical receptors (mechanoreceptors) that communicate with the muscles for support turn off and the pain receptors can be turned on. This injury is most commonly called a sprain.

So, when a force from an auto collision does damage to your spinal ligaments they are no longer able to hold the spine in alignment. This is what they look like:

See how in the image marked “Normal” the ligament keeps the spine aligned, but when it is damaged it allows it to slip? Remember spinal ligaments hold vertebra (spinal bones) together and keep the joints aligned; when they are damaged, they cannot maintain alignment and the joint will show excessive motion in one of two forms: a “back and forth” motion called excessive translation motion or bending motion that causes excessive joint angulation. This is generally not diagnosable on an MRI; it is diagnosed with a simple set of special x-rays called stress x-rays, along with a sophisticated measurement analysis called a Computerized Radiographic (X-ray) Measurement Analysis, or CRMA for short. This specialized technology will allow any radiologist to accurately measure the intersegmental motion patterns of your cervical and lumbar spine and tell your doctor where the most damaged units are based on their excessive motion patterns.

As a consumer, you need to understand that translation patterns are how much the vertebra is moving or slipping front to back. There is a normal range, an abnormal range, and a severely damaged range. Look at the example translation charts below, which are from actual studies.

Where there is more than 1 millimeter of excessive translation it is abnormal. Anywhere there is more than 3.5 mm of aggregate motion we have a severe ligament problem. In this case, there is 2.15 mm plus 2.03 mm, adding up to 4.18 mm at Cervical Vertebra number 6 (C6). If I ask you to look at the chart and identify where the problem is, I think you will agree it is very apparent that the problem is at C6. Any doctor now could make this diagnosis.

Take a look at a very common injury pattern with those that suffer from headaches.

At C2 or Cervical Vertebrae 2 right? C2 = 3.81 mm which is severe.

How about this one?

At C5 and C6 right? This isn’t difficult to understand.

How about this one?

It is indicated here that all the spinal ligaments are severely damaged. Again, the location and determination of a spinal sprain injury is ascertained by the amount of abnormal or excessive motion in the individual vertebral motion units.

What I have shown here are the basics, and unfortunately in some cases you will now know more than many doctors do about this condition. Spinal sprains (ligament injuries) are accurately measured and determined with this simple test. Your doctor really cannot accurately determine this without a decent set of stress x-rays and a CRMA test.

This test and its findings are so important that the test should be performed independent of the treating provider! That way there is no bias entered to the study.

Remember, excessive spinal motion is not found on an MRI. An MRI is a test to determine if you have a disc injury, independent of an excessive motion study like an x-ray and CRMA. The disc is a spinal ligament and is one of the ten total ligaments that hold your vertebrae together. The image of the spinal ligaments below illustrates that the disc is between the vertebra and acts as a cushion pad between them.

In the spine, it is reported that the total number of specialized ligaments is about 220. These ligaments hold the spine in perfect alignment and directly communicate information to 120 specialized muscles that allow you to use your spine without pain. Of these 220 ligaments, 23 are called discs, which means that the discs represent less than 10% of the ligaments in the human spine! An MRI in general is a study of the discs and therefore has some extreme limitations in a spinal ligament injury analysis. In fact, too many doctors today think that if you have a negative MRI you do not have a spinal ligament injury… but nothing could be further from the truth. Ligament injuries cause excessive motion and excessive motion is not tested for with an MRI!

Today’s spinal ligament injury specialist is a provider that knows how to use the special spinal x-rays and the CRMA Procedure to determine the severity and location of the spinal ligament injury, through an excessive motion study of your spine as well as an MRI to appropriately study the ligaments called discs IF needed.

Getting any spinal ligament injury accurately and fully diagnosed is the first step to recovery and it is the most important step when you have this type of injury. Do not take this lightly, never work with a doctor that does not understand and apply the basics explained here. The risk of long term chronic pain or other chronic problems combined with the long-term expenses are far too great!

If a doctor or their office staff cannot answer these three basic questions you are probably not in the right office. The questions are:

  1. Doctor, could I have an injury to my spinal ligaments? If the answer is yes, then ask:
  2. Can spinal ligament injuries cause a patient significant, long-term problems if they go undiagnosed? If the answer is yes let them explain all about it (remember the symptoms above that are associated with this condition) and then ask the following most important follow up question.
  3. How do you, or your clinic, accurately diagnose this condition? They should answer that they do an intersegmental motion study with special x-rays and a CRMA procedure, followed by an MRI if they feel it is necessary. If they cannot quickly tell you this, then you are probably not in the right place.

Your health is too important to turn over to a doctor that is unfamiliar with the condition that you have. If you had cancer would you try to train your treating doctor or would you expect them to be an expert already? The spinal sprain is no different. I would never let any of my loved one’s work with a doctor that does not fully understand the condition that they are treating. This is rampant, and in my experience, it is why this relatively simple condition is now causing so many people to suffer. Choose your doctor wisely!

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