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20/Feb/2018

The 3 biggest pitfalls with using MRI for spinal ligament injury diagnosis are the following:

1. MRI usually leaves 90% of the possible ligament damage to a spine undiagnosed.

2. MRI does not image the most important derangement pattern found in a spinal ligament injury.

3. MRI does not routinely diagnose the severe upper cervical ligament injury.

Pitfall #1: MRI usually leaves 90% of the possible ligament damage to a spine undiagnosed. To fully understand this first pitfall, look at the anatomy of spinal ligaments and compare to a typical MRI report.

Two vertebra = a human Spinal Motion Unit.

There are 10 ligaments that hold each Spinal Motion Unit together. (There are only 8 ligaments named in the illustration because the capsular ligaments and the transverse ligaments come in pairs, with one on each side.) One of these ligaments is the intervertebral disc, which means the disc is 1/10 or 10% of a Spinal Motion Unit’s ligaments.

No one is ever going to say that the disc is not important, however what about the other 9 ligaments?

To illustrate this, look at a typical MRI report:

The Report starts at C2-3 because that is the first disc space in the human spine

Nowhere is this report are any of the other ligaments mentioned.

MRI has the possibility of being so much more. The machine produces fabulous images but the MRI report content is greatly minimized down to merely a “disc study”. The reports do not address the other 90% of spinal ligament injuries that can exist.

Pitfall #2: MRI does not image the most important derangement pattern with a spinal ligament injury: Excessive Spinal Motion.

Normal Alignment: when forces that are tolerable act upon spinal ligaments, they remain undamaged; the spine stays in a normal alignment pattern and there is not excessive motion detected. The yellow line on the image is the anterior longitudinal ligament, just 1 of the 10 ligaments that holds a normal Spinal Motion Unit in alignment.

Spinal ligament injury = Misalignment: When spinal ligaments are overcome and damaged by the forces they hyper- stretch, tear or snap in two (avulse) and this always results in excessive motion and instability in the affected joint(s). If the unstable joint is impinging on the spinal cord it causes myelopathy. Impingement of an unstable joint on the spinal nerve causes neuropathy, or it simply causes pain. These are all clinical manifestations of spinal instability. This is excessive spinal motion causing a neurological problem.

Ligaments are tough, flexible tissue that holds bones together to form a joint. It is the job of ligaments to keep all bones in proper position and to allow normal motion in the joints themselves, resulting in proper alignment and proper motion of the joint. When the ligaments are damaged, the bones would start to have excessive joint play or laxity in their movement patterns. This is very easily measured and quantified with special x-rays and an accurate measuring system.

It is not the purpose of an MRI to detect or report on excessive motion in the joints. That is the job of the most inexpensive and accessible imaging that there is which is x-ray, and more importantly stress x-rays.

Pitfall #3: MRI does not routinely diagnose the severe upper cervical ligament injury

Diagnosis means to identify the nature of an illness or injury by assessment of the symptoms (subjective – what the patient complaining of) in conjunction with examination of observable signs (objective – what can be measured, seen, etc.). Nothing may be more productive of symptoms than those associated with damage to what is called the craniocervical junction. The most common symptoms are neck pain, headaches, migraine headaches, cognitive impairment, and visual disturbances.

The craniocervical junction comprises base of the skull (cranium-head), plus cervical 1 (atlas) plus cervical 2 (axis).

The skull is attached to the body by ligaments. The specialized ligaments of the craniocervical junction must allow for stability, yet allow functional movement of the head upon the body. What makes this area so important is that it is traversed by major blood vessels, lymphatic channels, and a great deal of nervous system tissue (spinal nerves, cranial nerves, and the spinal cord). The spacing is tight. Everything is held in alignment (proper spacing) because of these ligaments.

There are two major joints systems in this junction: the atlantooccipital (head to C1atlas) and the atlantoaxial (C1 atlas to C2 axis) joints. These joint systems are extremely different. The atlantoaxial joints allow for about half of the necks range of motion in flexion and extension, but almost no rotational movement. The atlantoaxial joint allows for little flexion and extension movement, but accounts for 25-50% of right and left rotation.

This area is being intensively researched at this time because there is so much neurology, blood flow, lymphatic flow, and cerebral spinal fluid flow associated with this small piece of bodily real estate. Everything that is important for the communication of the head to the body goes through this small area. It is all kept attached, separated, and in alignment by a series of small tough ligaments, called the ligaments of the craniocervical junction. The ligaments we are talking about are everything that is above the C2-3 disc space. Since there is no disc found in this area it is almost never mentioned in a standard cervical MRI report.

The procedure of measuring things in x-rays is very old, probably as old as x-rays themselves. Today measuring excessive joint motion on x-rays of the spine is perhaps one of the most important procedures that can be done. Yet there are very few radiologists that perform this, for one very important reason: they do not have a computer program that allows them to do it accurately.

Spinal Kinetics, LLC that has developed its own technology for doing just that. The process of accurately measuring spinal motion, is called Computerized Radiographic Mensuration Analysis or CRMATM for short. This is quite a simple process in a very complicated field of imaging. Images today come in different formats (arrangement of form), at different outputs and are shot at different distances. These factors and many more are important for capturing good quality films, and can affect the ability to get an accurate read. Therefore, Spinal Kinetics developed their own system for their Board-Certified medical radiologists to use the CRMATM program on any set of spinal x-rays taken in any state in the United States of America.

 

 

Accurately detecting excessive spinal motion is even more powerful in the setting of positive findings of a disc herniation on an MRI. When a patient has a disc herniation the first thing their provider should be thinking about is “how bad is the excessive motion”?” A disc herniation along with damage of any of the 9 other ligaments (comprising a spinal motion unit) can result in excessive motion at the same spinal motion unit or at the units above or below the disc herniation. This is a serious, complicated soft tissue injury.

To summarize the 3 pitfalls with MRI and spinal ligament injury diagnosis:

  1. There are 10 ligaments that hold a spinal motion unit together (disc is one of them) and yet the MRI report usually only mentions damage to the disc and nothing else. MRI is generally only reporting on 1/10 of the spinal ligament structure, which leaves the other 90% undiagnosed.
  2. MRI is not designed to tell us how much excessive motion damage (instability) the spine has taken from the injury. This omits perhaps the most important finding, as it begins to tell us a lot about the treatments that would be most beneficial and it gives us a great understanding of the time involved with treatment, the expected outcomes and it gives us an early indication of the follow up supportive care the patient may require to maintain the gains from treatment. A disc herniation can be a serious injury, however a disc herniation with no excessive joint movement and one with severe joint movement are two completely different disc herniation’s!
  3. MRI does not routinely diagnose the severe upper cervical ligament injury

Conclusion

Spinal ligament injuries are some of the most significant injuries that any human body can receive, simply because they put the patient at such high risk for long-term residual complaints. Often these complaints are not accompanied by accurate documentation of physical findings, simply because the doctors that are working with these patients are not aware of what such injuries look like.

In this report, I chose not to focus on such things as MRI signal intensities to pick up ligament damage or other such complicated and often variable procedures. These injuries can be very easily picked up with standard stress radiology there was no need to get any more complicated.

All problems are resolved by applying basics. The purpose of this report was to bring to the forefront the simple imaging procedures that are not being standardly applied today.

Every patient suspected of having a spinal ligament injury should be tested with simple stress radiology and a CRMATM excessive spinal motion study. I hope that this report was straightforward enough to provide you with a great understanding of why. When patients are not in the hands of doctors that understand their injuries, their clinical outcomes obviously can be questionable. Time matters in these types of injuries, as every day the patient goes without a clear understanding of what they have the greater the risk the patient can wind up with a symptom that becomes permanent. Spinal ligament injuries are permanent, but the symptoms produced do not have to be.

Spinal Kinetics LLC (www.thespinalkinetics.com) performs that specialized CRMATM excessive spinal motion study on any set of x-rays in the country. We as a company are doing our part.

The American Spinal Injury & Impairment Consultants educates professionals in much greater detail on these injuries. I have developed an online professional training program that can be found at www.smartinjuryeducation.com.

For everyone that in any way assists the injured public, it is my sincerest hope that this information will provide you with the basics of imaging.

by: Jeffrey A Cronk, DC JD

References:

1. http://www.lanjochiro.com/2012/08/what-is-forward-head-posture/ 2.https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812013
3. www.thechiropracticimpactreport.com 4.http://americanpainsociety.org/uploads/education/guidelines/evaluation-management-lowback-pain.pdf 5. https://www.sciencedaily.com/releases/2012/09/120911091100.htm

6. http://thejns.org/doi/pdf/10.3171/2011.1.SPINE10612 7. http://thejns.org/doi/pdf/10.3171/2011.1.SPINE10612


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20/Feb/2018

Dr. Lesko is a new breed of Chiropractor, but what does that mean?

-Must have impeccable credentials and training in the areas related to trauma such as MRI interpretation, Accident Reconstruction, Spinal Bio Mechanical Engineering, Spinal Trauma Pathology, Medical Legal Documentation, Triaging the Injured and more to help render an accurate diagnosis, prognosis, and treatment plan. These credentials must be obtained formally through highly respected medical and chiropractic schools to ensure admissibility in the Courts.

-More than ever, being able to accurately diagnose and reconstruct what happened in a car accident so that he/she can connect causality, bodily injury, persistent functional loss, permanency must have the proper training and credentials to do so. This includes knowing, understanding and documenting the latest medical research related to traumatic injuries, connective tissue injuries, disc definitions, reading and understanding MRI’s, low speed impact collisions, understanding AOMSI (alteration of motion segment integrity) and how AOMSI is much worse than a herniated disc (per the AMA Guides to the Evaluation of Permanent Impairment ratings). In addition, accurate diagnosing and utilizing the research on connective tissue injuries (strain/sprain), and how to properly write a narrative report that demonstratively explains and communicates all of this simply.

-Must be willing to refer the patient to specialists when appropriate such as an orthopedist, pain management, neurologist, neurosurgeon, and have open dialogue with those specialists to best serve the patient’s medical needs.

-Credentials will be admissible in a court of law through Voir Dire, Daubert or Frye hearing. These admissible credentials will allow the chiropractor to opine on MRI findings, Connective Tissue Injuries demonstrable by digitized flexion and extension x-rays, AOMSI, Accident Reconstruction and other critical areas related to injury. This can lower trial costs considerably if only one expert is needed.

-Will not be confused by deceptive defense rhetoric in documentation or the courtroom.

-Will understand and communicate the scientific medical literature clearly showing that pre-existing injuries and arthritis are RISK FACTORS that can cause the patient to sustain MORE INJURY WITH LESS FORCE rather than letting the deceptive rhetoric of the insurance company call it a “pre-existing” injury.

-Will understand and communicate that low speed impact collisions can cause a host of serious and permanent injuries and that the insurance company’s deceptive rhetoric stating that “no damage=no injuries  does not match up with the current scientific literature on the subject of low speed collisions with minimal or no damage to vehicles.

-Must not allow an insurance company DME doctor to discharge his/her patient based on faulty DME examination procedures. This new doctor will push back and write IME rebuttals that will make the insurance company and IME doctor take notice that we will not tolerate unethical tactics on his/her patient and when indicated will render licensure complaints against all DME’s that do not report the truth. 

This is the New Paradigm for personal injury in Texas and the nation. Yes, it’s getting harder for both doctors and lawyers. Yes, the insurance company’s tactics are tough and all too often underhanded and unfair. But … hard work, ethics, proper training, credentials, and knowledge of the scientific facts will allow us to prevail in should you go to trial.

If you would like assistance with a client who is being denied a proper settlement and feel there may be more to the case, please feel free to contact our office at any time for a free consultation.

To view my entire CV, please click here. 

Thank you.


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20/Feb/2018

Why have a doctor treating you that does not understand the condition that you have or, even worse, may be missing your real injuries? Doctors who understand the spinal ligament injury know how to properly diagnose it (X-ray, CRMA, MRI). They know how to properly identify both the severity and the location of this type of injury. If they do not and you are treating with them, in my experience your chances of an optimal recovery can be significantly reduced, which means that you may needlessly suffer for the rest of your life. Before you treat with any doctor for a spinal ligament injury, a sprained back or neck, or whiplash, make sure the doctor knows how to locate, and determine the severity of this injury. How hard is it for a doctor to take some x-rays and send them into a service where highly trained radiologists can perform an accurate spinal intersegmental motion study of the injured of the area? It’s not hard at all; do not tolerate those who do not know what you now know!

Today it is equally as irresponsible to simply hire any personal injury attorney to help you. You are going to be paying them a good portion of your benefits money for what, in many cases, is not so much legal work on their part. They do not charge by the hour in personal injury cases. I am not saying that personal injury attorneys do not work; rather they do not do much legal work and would prefer to become more of a settlement broker than an attorney. I say this because law is practiced in a courtroom, yet it is reported nationally that only 4-5% of any injury cases ever end up in court. 4-5%! I think the actual numbers are closer to 1-2%.

Since you are going to be paying them a good amount of your money out of any of your benefits, you should hire an attorney that understands both your condition and what the insurance company’s documentation needs are, and they should be able to explain both to you. They also need to understand what the common testing procedures are for these injuries. They need to be familiar with injury coding so as to make sure that all of your injuries are properly listed in their final demand report. They need to include your impairment rating, your loss of enjoyment of life (LOE) factors, and any DUD, Duties under Duress factors from your permanent injuries.

If these BASIC things are not in their final report to the insurer for your settlement request, your chance of getting a fair benefits package are slim to none in my experience. Your medical records are yours and you can get a complete copy of them any time you want to. Remember it is stated that 40% of diagnoses are wrong and this can cause you injury, and in some cases a lifetime of avoidable pain and suffering. If you think something has been missed or is missing in your file you can ask your provider to correct it.

When you hire an attorney, they are working for you. Anything in their files, including their demand package or settlement report, is yours. You can ask your attorney to review it with you at any time, and I highly recommend that you do. Have them thoroughly explain everything that is in it and, if the above stated items are not in it, have them explain why? Remember they are working for you – you are their employer. If you want something reported to the insurer by them, you have every right to demand it.

Doctors and attorneys are paid very well. They may whine that this is not the case, but usually they whine from some of the nicest neighborhoods in America. In my professional experience, it is okay that they should be pressed to be highly effective. The truly good doctors and attorneys will not mind at all. In fact, they will appreciate an educated consumer.

I really hope that you will take the time to apply what you have learned here. Do not take these spinal injuries lightly. Find a doctor that knows or specializes in this type of injury and then follow everything they say to do to the letter. Ask questions, but follow their instructions, as they have usually put many before you successfully through this process!

I want to conclude with my thanks for taking the time to read this through to the end, giving me the opportunity to provide you with insight that can truly help either yourself or the people that you care about. Thank you.

I also want to thank the truly gifted doctors that have persisted through the storm of misinformation that has existed, and instead stayed the course and truly provided great results for the many patients that suffer through these injuries!

I want to thank the attorneys that have stayed current on both the significance of these injuries and what the insurance industry documentation needs are. These are the attorneys that do NOT interfere with patient care, but rather become a huge support to both their client and the doctors that serve that client.

Lastly, use the information in the report to help you choose your medical and legal help wisely. Your health and finances can be detrimentally affected – perhaps permanently with the wrong choices – so choose as wisely as you can and always ask questions! Remember these professionals are working for you!


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20/Feb/2018

The insurance industry is often made out to be the bad guy in the injury environment. In my experience this is usually not the case, even though they, too, have caused huge issues in this area. When it comes to your benefits, documentation is key! Who are the bad guys then? They are the professionals that do not know the basics of what any insurer needs for documentation. Insurers today still use artificial intelligence to adjudicate claims, which means that the adjuster who is going to complete a claim for you will be asked a series of questions from a computer. Computer Sciences Corporation owns the Colossus insurance software program, and this is what their company states about that program on their company website:

Your adjusters can quickly interpret medical reports and look up definitions of injuries, treatments, complications and permanent impairments using AMA 5th edition data. Through a series of interactive questions, Colossus guides your adjusters through an objective evaluation of medical treatment options, degree of pain and suffering, degree of permanent impairment to the claimant’s body, and the impact of the injury on the claimant’s lifestyle. At the conclusion of a Colossus consultation, a summary of the claim is provided, including a recommended settlement range.14

Understand that in order for an adjuster to easily answer the questions that the computer is asking them, the answers have to be found in BOTH your doctors’ reports and your attorney’s report. In other words, the attorney also must state the same documentation facts if they are involved in the claim resolution process. Here are the typical questions.

  1. What are the injured parties’ documented injuries? All injuries are coded with an international coding system language called and International Classification of Disease 9th Edition code (ICD9). The proper codes are entered in into the system, which means your injuries get entered as long as they were identified and properly coded. Look up any injury on the Internet and you will see that it has a corresponding ICD9 code. Sprain of the cervical spine is listed at 847.0, so that would be entered into the computer if you had this injury. If the doctor noted ligament laxity as an injury you would see the code as 728.4.
  2. What are all the care procedures that were delivered to the insured by any health care provider? These are also specifically coded in all your medical records with international procedural codes.
  3. Does the injured party have any permanent injuries identified with a Permanent Impairment Rating? This is the way the insurer knows that you have some sort of permanent problem; with no impairment rating, there is no permanent problem.
  • If you have a permanent impairment it will ask how much? This is in the form of a number, such as 2%, 10%, 25%, etc.
  • If you have a permanent injury it may ask if this permanent injury now keeps you from doing any kind of activity that you could perform prior to the accident. This is called “any loss of enjoyment of life factors.” These are things that you can no longer do as a result of your injuries. It is very important that they are included and well documented in your doctors’ notes and in what is called your attorney’s demand package. The insurer needs to know what you now CANNOT do, that you could do before the accident.
  • The adjuster will also be asked if there are any activities that you can do but only under duress since the injuries occurred. These are called “Duties under Duress factors.” Things that are now uncomfortable to do, but you can still do, they are simply interfered with due to discomfort that is a direct result of your injuries.
  • If you have permanent impairment the software may also ask the adjuster to indicate if there are any documented future care needs that will be required to manage your permanent injury. This is called “Future Care Expenses” that may be projected or anticipated to help manage your situation.These make sense, and all of this information is factored into a claim to adjudicate what benefits you are rightfully entitled to. While logical, they are almost never found to be completely or accurately documented in either your doctors’ notes or in your attorney’s benefits demand package. This can cost you a great deal of benefits and leave you with some very large medical bills that you may end up being personally responsible for.Notoriously, what happens is you received large care bills that the doctor’s documentation does not support the need for, so your insurance company denies them and does not pay for the care. Your attorney takes this poor documentation and passes it onto the insurer because they do not know how to correct it. The unfortunate result of both activities is that access to your rightful injury benefits is unnecessarily denied.Here’s an analogous situation to show the point; lightning strikes a huge oak tree next to your house and it crashes into the side of your house and damages (injures) two floors of your home, but your home repair contractors significantly under-document the damage. Your insurer wants to pay for the damage that was documented, which is a much lower number than that which will cover the actual damage. You may think the insurer is trying to rip you off, so you hire an attorney. The attorney now does not know how to document your house damage properly and they cannot fix the problem – their documentation is simply the original crappy documentation that is causing the problem in the first place. Is the result likely to change? No, of course not – but now you have bad benefits, your house damage is not fully covered and now have your attorney to pay as well.

    This is exactly what is happening every day with injury benefits. Really bad documentation!

When this under-reporting happens, of course the insurer is going to think that some sort of fraud is being perpetrated, and of course your attorney – and even your doctors – will all say it is the insurance company just trying to save money, while in fact it may indeed be the ineptness of both your attorney and your doctors that may be the problem.

In summary, your doctors and attorney must report these basics in their documentation:

  1. Proper codes for all your injuries and care
  2. Any permanent damage must be reported with an AMA impairment rating
  3. Anything you could do before injury and now cannot do as a result of your injuries, called Loss of Enjoyment of Life Factors
  4. Anything that you could do pain-free prior to the accident and now can be done but only under duress, called Duties under Duress Factors.
  5. If you have permanent injuries identified, all the future care your doctor advises that you may need has to be formally documented by your doctor (s) and reported by your attorney

It’s simple, yet 98% of the files that I have ever checked from both the doctor and the attorney are missing this basic information. That is why it is so important to find the right doctor and, if needed, an attorney that understands both your injuries and your documentation needs. Otherwise you could seriously suffer financially with the loss of benefits that were RIGHTFULLY denied, simply due to the documentation blunders that could have been avoided.

 


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20/Feb/2018

The biggest problem in the medical legal system with injuries and compensation was twoi fold in nature:

  1. How to set up a standard system to determine if permanent body damage has occurred with an injury.
  2. The second problem was how to objectively and standardly determine the effect that this identified injury would have on a person’s ability to perform their basic activities of life without pain, discomfort, or suffering.

This monumental task was accomplished in 1970s when the AMA published the first Guides to the Evaluation of Permanent Impairment, which could be easily renamed the “Guides to the Evaluation of Permanent Injury” because that is exactly what impairment is: a condition that injures the person’s ability to function.

This book is the “Kelley Blue Book” of body damage; every doctor treating injuries and every attorney representing injury cases should be very familiar with it. They should readily be able to use it to represent to anyone that you have a permanent injury, and the level of negative effect on a person’s life this injury is agreed to have. The word “objective” means anything that can be verified by others. The chair you may be sitting on can be verified to exist by others, but how you feel in it cannot.

When we look at the AMA Permanent Injury Guides I think the stated purpose of this book says it all: “The primary purpose of the guides is to rate impairment to assist adjudicators and others in determining the financial compensation to be awarded to individuals who, as a result of injury or illness, have suffered measurable physical and/or psychological loss.”12

These books are made so that anyone can look up the identified injuries to any body part, and see what the agreed upon negative consequence are as communicated in the form of a impairment rating. Let’s say you have excessive motion of the spinal segment from a ligament injury that is ratable. If you look up an injury and the book states that the injury can cause a negative consequence to 25% of your activities of daily living, – reported as a 25% whole person impairment – it means 25% of your daily activities may be negatively influenced by this injury. While this is not a perfect system, it does prove that the condition exists, it will negatively impact your life, and it is a worldwide agreement.

The key to this is that it is not the treating doctor stating this – IT IS THE AMERICAN MEDICAL ASSOCIATION!

So, any injury doctor or injury attorney that is not fluent in impairment rating and the AMA’s permanent injury assessment is way out of touch and can seriously reduce your compensation benefits, causing you to possibly be responsible for very large unpaid medical bills.

Once again, Spinal Kinetics put a very good short video on the AMA guides called Spinal Ligament Injuries –Was the AMA Wrong?

(https://www.youtube.com/watch?v=ofmpiE5BP6g)

Mark Blane, a well-known San Diego personal injury attorney, states this about the AMA Guides in his book How to Effectively Document Your Patient’s Personal Injury Case from A to Z: “…your biggest piece of medical evidence in terms of allowing your patient’s lawyer to argue or substantiate appropriate case settlement value is, besides your actual documented injuries, is whether your patient has a medically documented impairment to a function of a body part or parts.” He also states the following about the spinal ligament injuries: “This is probably the worse soft tissue injury diagnosis you could have from an accident. Essentially, it is a ligament instability injury. It affects the neck and lower back (the mid back is protected by the rib cage).” He goes on to say, “This could occur in a rear-end collision that damages ligaments of the spine. Such damage can affect your vertebra’s proper range of motion. Blood can stagnate and cause poor blood supply in the spine, which can lead to degenerative conditions such as bone degeneration and early arthritis. You could also experience continual pain long after the accident. Post-accident, you should make sure to seek medical attention and the advice of a knowledgeable injury attorney. Some doctors and injury lawyers routinely miss these medical diagnoses.”13

This book can be purchased on Amazon.com.

The essential point is this: you should always work with a doctor that knows how to find and diagnose this condition. In fact, I believe that this injury (the spinal ligament injury Mark speaks of here) is so important, so well documented in how you find it, that any doctor that misses this injury should be found guilty of malpractice. Especially if the patient can be shown to have suffered avoidable consequences as a result!

Why work with any doctor or lawyer that does not clearly understand your injuries?

AMERICANSIIC.COM • COPYRIGHT © 2015 PAGE 29


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20/Feb/2018

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!

AMERICANSIIC.COM • COPYRIGHT © 2015


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20/Feb/2018

The spinal ligament injury is the number one cause of pain, disability, and expense in the market today. To seriously reduce your risks, you will want to work with a doctor that fully understands this condition.

Therefore, you must take this condition very seriously. I am so serious about this part. You see that patient that comes out of this type of injury with chronic pain is often going to spend a LOT of money on future medical services should they seek the help of medical professionals. The WHY here is easy to understand as spinal ligament injuries are notorious for causing chronic pain and chronic pain in America is EXPENSIVE to medically manage – as medicine is not great at managing this particular problem (chronic musculoskeletal problems), unless of course the idea of expensive addictive drugs it what you are looking for.

Look at this research that shows just how many people come out with chronic pain from a most common injury mechanism, the auto collision.

In one of the longest studies ever performed on whiplash-injured patients looked at the health status of those same patients 17 years after their injury. 55% of the patients still suffered from pain caused by the original trauma.

This research implies that no matter what doctors did that treated these patients, 55% of the them had the same problem 17 years later! Do not become a statistic by working with a doctor that does not specialize in the rehabilitation of these spinal ligament injuries! Don let anyone you know or care about become a statistic as well.

When a doctor does not understand, or cannot find the physical cause (diagnosis) of a patient’s condition, or the symptoms don’t add up to what they are used to seeing then the doctor may begin to believe that the condition is just in the patient’s head.

I will give you an example from the list of common symptoms that are associated with a spinal ligament injury as listed above and tell me if you cannot see this happening with a doctor that does not know how to diagnose this condition. Remember these same doctors could not tell you the common symptoms of this condition which makes it hard to get an accurate diagnosis, as diagnosis is just working backwards from the patients presented symptoms to finding the physical cause.

So, Mary goes to her regular doctor after being in an auto accident last week. When she sits down with her doctor she reports that her left ear has some pain in it, it seems that she has some ringing in her ears that is more pronounced at night, and she seems to be forgetting things, has some difficulty concentrating and she seems to have some neck pain that comes and goes and she has noticed that she is getting some headaches, when she used to never have them before.

Trust me when I tell you – in my experience the first thing the doctor is thinking is Mary is just too sensitive and this may all be in her head. Check out the symptom list and you find that all of Mary’s symptoms in this example are associated with a normal everyday spinal ligament injury, which is usually easy to treat if caught early. Instead Mary’s doctor again thinking this is a bit of a head case, may ask Mary such questions as, “has there been and recent major changes in your life or any stresses that are new”? Where do you think that line of questions is going? Some of you may have experienced this in the past and know exactly what I mean. Some of you know friends or family that have walked out of a medical visit like this one described above and are now on some form of Psychotropic drug!

Talk about the wrong diagnosis, and this happens all the time. Moira Dolan, MD writes to inform patients about these drugs, in here book the No-Nonsense Guide to Psychiatric Drugs found on Amazon: https://goo.gl/rSED14

If you or someone that you know has had this experience, this book is a great start to understanding how these drugs are used.

Now here is the good news, or bad I guess depending on how you look at it. Research tells us it is not in your head, but more likely in your doctor’s inability to diagnose a simple ligament injury.

Here is some research that addresses the myth that your pain is created “from your mind.”

A study found that essentially 100% of those who are suffering from chronic pain caused by a whiplash injury will have an abnormal psychological profile with standard assessments. The only way to resolve the abnormal psychological profile was to successfully treat the chronic spinal pain; psychotherapy was not able to improve the abnormal psychological profile nor was it able to improve the patient’s chronic pain complaint.

Thus, your pain is not being caused by the abnormal psychological profile; rather the pain is causing the abnormal psychological profile. If your doctor seems to be indicating that it is “all in your head,” then perhaps it is time to get a second opinion or change doctors.

The physical issues of spinal ligament injury are most heavily documented in cases of whiplash, although a ligament injury can occur from many mechanisms in many different environments: work, home, sports, etc. The mechanism of injury from an auto accident is very well studied because we carry insurance to cover our injuries and the injuries that we may cause others. It has been so heavily studied because there is a lot of money at stake!

In May of 2015, the National Highway Traffic Safety Administration put out a report that looks at trends in highway accidents. It then provides the American taxpayers a report of their findings.

In 2010, there were 32,999 people killed, 3.9 million were injured, and 24 million vehicles were damaged in motor vehicle crashes in the United States. The economic costs of these crashes totaled $242 billion… In Appendix A… The results indicate a feasible range of societal harm from motor vehicle crashes from $546 billion to $1.12 trillion in 2010, with lost quality-of-life accounting for between roughly half and three-quarters of all societal harm respectively.

That’s a lot of money at stake, which is why this is such a heavily studied injury.

As listed in the study, nearly 4 million people a year are injured in automobile accidents. From our research above if you take this condition lightly, over 2 million of you are going to be chronically suffering with the same problems 17 years later! This means that that the pain is now classified as chronic, which is defined by any condition that persists for more than three months.

To be clear, this means that over 2 million people develop chronic conditions from this one mechanism—EVERY YEAR! Injury is the primary cause of chronic pain, and chronic pain is a serious problem today. Per the National Institute of Health Report, in 2014 over 100 million American Adults suffered from chronic pain , and according to the Mayday Fund over 20% of Adolescents suffer from it. There is no bigger health problem in the world today than chronic pain. At American Spinal Injury & Impairment Consultants, we believe the world deserves better solutions… starting with your doctor.

It is important to understand this. To get out from the 55% you must find a doctor that can help you as quickly as possible.

Remember this: “Injury is the most common initiating event to the disease called chronic pain.” – Dr Jeffrey A. Cronk, DC, JD

So, if you want to look further at studies that show just how poor doctors’ results are with patients that have been treated for these injuries, please watch Whiplash Statistics Don’t Lie on YouTube (https://www.youtube.com/watch?v=st5bwC411VU). This is published by one of the top Spinal Ligament Injury Testing Companies in the United States called Spinal Kinetics (www.TheSpinalKinetics.com) Spinal Kinetics in the leader in the testing procedure that allows doctors to accurately determine the severity and location of spinal ligament damage.

Now let’s talk about costs – your costs – and why it is so necessary to stay out of the money pit caused by chronic pain. Chronic pain and its caustic expenses can leave you quite poor!

The American Pain Society, one of America’s most prestigious medical groups, explains the following in their 2007 publication of lower back guidelines:

Medical treatment for chronic low back pain is estimated to cost $9,000 to $19,000 per patient annually, and interventional treatments cost a minimum of $13 billion in 1990. Additional costs are associated with days lost from work due to low back pain. Low back pain is the most common cause for chronic or permanent impairment in U.S. adults under the age of 65, and the most common cause of activity limitations in persons under the age of 45.

In another recent study on chronic pain published in the Journal of Pain, the average American can spend more than $12,000.00 per year in additional medical expenses treating their chronic pain. After 10 years that is $120,000.00, which is a lot of deductible and copay expenses. This is BIG, BIG business and we want to keep you out of this expensive money pit!

Therefore, it is so important to choose your doctor wisely. Your health and your future finances can severely depend on it!

AMERICANSIIC.COM • COPYRIGHT © 2015


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20/Feb/2018

Upon hearing the term spinal ligament injury, your first thought may be, “That can’t be the problem, it sounds too benign (minimal).”

It is not. This is a serious injury.

While I cannot begin to teach you everything there is to know about this type of serious injury, I can and will improve your ability to be a much more educated consumer, helping you shop the market for the best results. This includes locating an informed doctor with expertise about this condition, and more importantly, how to accurately determine where and how severe it is if you have it.

If you think that you have injured your spine in an auto accident, work activity, sports activity, a slip and fall, or any of the hundreds of other ways spinal injuries occur, this is for you!

To begin with, we need to understand that when a force suddenly overwhelms a spinal joint and forces it out of alignment, the ligaments are overstretched or torn. This can leave the joints looser, lax and out of alignment, which causes the pain receptors to turn on again. The result is to prevent you from doing further damage the joint or the ligaments.

This injury is called a sprain, or in this case, a spinal sprain. Sprains provide you with either a very sharp pain or a very attention-grabbing dull ache. Anyone that has sprained their ankle knows how painful a simple injury to the ligaments can be. The pain you can receive from the mildest form of an ankle sprain can be extremely overwhelming.

The common term for a spinal ligament injury caused by an auto accident is called whiplash injury. That is because of the “whipping” motion that occurs during the accident. Regardless, it is a spinal ligament injury and it causes a degree of instability to the spine itself.

Symptoms of spinal ligament injury 

Medscape1, one of the top medical sites in the world, openly educates the public about spinal ligament injuries to the neck or lower back, and lists the following symptoms:diseases (e.g., malaria), the forces of war and nature, and all neurological conditions combined. Thus, this report is stating that these so called “just soft tissue injuries” have a greater impact on the health of the world population than all the aforementioned conditions combined! A spinal ligament injury can cause you to have any of the following conditions and it may affect you permanently:

 • Neck pain • Back pain • Lower back pain • Shoulder pain • Scapular pain • Pain radiating down the arms • Pain radiating down the legs • Disturbances in concentration • Disturbances in memory • Concussion Findings • Numbness, tingling or a sense of weakness or heaviness in the legs or arms • Visual disturbances • Ringing in the ears • Difficulty swallowing • Difficulty breathing • Bladder or bowel dysfunction • Headaches (migraine and others) 

Unfortunately, each one of these conditions can become permanent if you do not reduce your risk by working with a knowledgeable doctor that completely understands how to properly diagnose and treat this type of injury early. Early is the key! The sooner the better!

However, finding a doctor that knows how to properly diagnose this type of injury is not easy. In fact, I have taught more programs specifically geared to the spinal ligament injury than perhaps anyone in the country. I can tell you firsthand that 90% or more of the doctors treating these injuries do not know how to determine the severity and the location of this condition. In that case,, your chances for an optimal outcome are significantly reduced.

This also means that your risk of any of the conditions listed above becoming a permanent part of your life is increased astronomically! Finding the right doctor is imperative to reducing this risk. Thankfully, You’re in good hands with CHRC— Dr. Lesko is an educated Spinal Ligament Specialist, and ready to give you the care and education you need to overcome Spinal Ligament Injuries,

 

** Taken From The Seven Essentials to Getting Great Recovery Results and Excellent Legal Help for any Spinal Ligament Injury, Chapter One**


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20/Feb/2018

Can you think of a sport that anyone can play, that does not take moves that are practiced repetitively until perfected, or even previously played before you hit the field?  How about Gardening?

Although you may not have thought of gardening as a sport by definition, it does take physical exertion and some basic skills to participate.  There is even a team mentality in community gardens. As we learn more about the dangers of pesticides and genetically modified foods, the popularity of gardening is again on the rise, with 35% of all households in America growing their own food. Not only is there comfort in knowing that your food is safe, there is much pride in cooking from garden to table.

In addition to food gardens, landscaping is another project that is taken on every year to make our homes more attractive and so we can enjoy the beauty of flowers in bloom.  Whatever your style, you should look to a garden session in the same way that you would look at participating in a sport that you do not play daily.

Low back pain is a common complaint from gardeners, both large and small scale.  ‘A sprain, also known as a torn ligament, is damage to one or more ligaments in a joint, often caused by trauma or the joint being taken beyond its functional range of motion.’ The most accurate way to diagnose a spinal ligament condition is with a simple, yet cost effective, x-ray test. The most utilized treatment for spinal ligament problems is a series of adjustments to realign and stabilize the spine.

While working outdoors, we often push ourselves beyond our normal limits because it is not constant strenuous activity. Proper precautions should be taken to ensure that you do not overdo it.  Before you begin, you should warm up and stretch your muscles to avoid injury.  Yoga is a very good tool for this and can be incorporated by most anyone.  A few basic yoga exercises can be found here. In addition, you should know your limits of what you can carry and lift.  It may seem like carrying a few bags of mulch or soil is not a big deal, but if you are not used to it, you can easily injure your low back. You should also use good lifting techniques, such as bending at the hips and knees only.

These tips are very important, but do not overlook some of the less obvious.  It is very important to change position often, take your time (gardening is supposed to be relaxing), and stay hydrated.  Not only are you physically exerting yourself, you are outdoors in the warm temperatures and sun. If you have noticed that you experience more back pain in the warmer months, dehydration may play a part.

Most importantly, if you are experiencing back pain, call our office to discuss your condition and find out how chiropractic can help!


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20/Feb/2018

Neck Pain is NOT Normal!

Pain is the way your body tells you that it is, or has been, injured in some way!   The most common cause of neck pain is from an old or new injury to the spinal ligaments that causes a spinal instability.

The ABSOLUTE KEY is working with a doctor that knows how to diagnose it!

Neck pain is the number three cause of chronic pain in the country.   If you suffer from chronic neck pain, you are not to blame!

At our center, this condition in one of our main focuses.  We know how important it is to see an injured patient right away as TIME MATTERS!  The longer this condition goes undiagnosed, the harder it is to alleviate.

Nearly 60% of Americans said they would be hesitant to talk to a doctor about their chronic pain.   We don’t blame you one bit!  Most people simply do not know a doctor that they can trust to provide them with the kind of help that they are looking for.

We believe that trust starts with communication, and communication is FREE!  At our health center, we feel that any potential patient should have the right to discuss their injury or condition with one of our doctors, before they spend any of their time or resources with us.

If you or someone that you know has injured their spine, please have them schedule a time to come in and discuss with one of our doctors what makes our center different.

Injury and Chronic pain can seriously affect a person’s life and yet, in our experience, people are generally too quick to believe that just any doctor can help!  Find out what makes us different before you start by calling us today!


P: 512-835-6077

chrc.scheduling@gmail.com

F: 512-367-5970

2013 Wells Branch Pkwy, Suite 104

Austin Tx 78728