Often new patients come into my office with a chronic back condition and tell me they are frustrated with their doctor.
No matter how long they have been seeing their doctor, their condition has not improved. I always ask, “Did they do a digital foot scan? Did they take standing X-rays? Did they do an MRI?” In almost every case, the answer is no.
We have come a long way from the early days of chiropractic care, specifically in diagnostic tools. We have access to advanced technologies such as digital foot scans, X-rays, and MRIs that allow us to see inside a patient’s body. These diagnostics provide a wealth of biomechanical information that helps identify problems, educate the patient, and prescribe the right treatment plan.
The structural fingerprint
At the age of 17, Tony suffered a severe hyperextension injury to his lower back while playing hockey. For 10 years, he had been seeking help from many sources. Unfortunately, his results were limited as all of his physicians were looking for pathology and ignoring biomechanics, which were the actual cause of Tony’s problem.
Digital foot scan
The feet are the foundation of the body but are often overlooked. Scanning a patient’s feet is the first step in providing a full structural exam. The digital foot scan allows you to see how the feet are affecting the kinetic chain and if they are doing their job.
As you can see in the digital scan in Figure 1, the color comparisons are vastly different. The difference in colorization shows there is an imbalance in the two sides of the body, and sometimes it’s even seen in the front and back of the foot.
During the examination, I looked at Tony’s feet. He clearly had problems with all three arches. The right foot appeared to be pronated more than the left. His foundation was imbalanced and would most likely be part of the cause of his problems.
Just like a house, the body’s foundation is especially important, because everything else sits on top of it. Arch flattening or over-pronation is a common finding in people’s feet. When the foundation is not level, everything that sits atop is not properly supported. This means that normal foot mechanics can adversely influence the normal functions of the ankle, knee, hip and even the back.
Generally, scanning can show foot stability, balance, and the effects on the rest of the kinematic chain. Patients can see the difference in colorization and understand how much their arch is collapsed and failing to support their feet. Some foot scanners embed a pronation-specific index score within the color spectrum. This communicates the severity of the arch collapse to the doctor and patient.
Many tests can be done during the physical exam to ascertain structural status, but none provide the detailed biomechanical information that X-rays do. I choose to X-ray every new patient who hasn’t been X-rayed in the past year. From measurements of disc and bone degeneration to centers of gravity, X-rays help to rule out pathology, determine biomechanical faults, and are the only way to see the status of a patient in detail.
Also, improvements can be measured much more accurately if the status is known in detail at the outset. As in the X-rays in Figure 2, the doctor was able to show a definite improvement in the patient who was prescribed custom-made orthotics.
In cases like Tony’s, standing X-rays tend to show the majority of the structural findings you are looking for. A total of four preliminary X-rays were taken, and if necessary, additional X-rays would be done. On Tony’s X-rays, there were many subtle findings, but the lateral L-S showed more than enough reason for his 10 years of problems: His sacral base angle was 56 degrees and had a severe anterior gravity line.
Tony was suffering from a major imbalance in the L-S and pelvic alignment. This distortion created abnormal stress on areas of the low back that were not designed to handle them, yet no one had detected this previously.
Approximately 10 weeks after beginning Tony’s treatment program, he was X-rayed Tony again. He reported feeling “different” in his low back. Upon re-X-ray of the neck and low back, there were indeed significant changes.
The most obvious and most important was the change in the lateral L-S. Tony’s sacral base angle went from 56 degrees to 46 degrees. Knowing that normal is between 36 degrees and 42 degrees, this improvement was considerable.
Being able to show Tony the visual difference in his lateral L-S after ten weeks of treatment helped me communicate his improvement and educate him as to why he felt different. Today’s patient appreciates these kinds of visual education tools.
The digital foot scans, X-rays, and MRIs provide the pictures that communicate the message. They educate and motivate the patient as to what their biomechanical status is, why they need to act now, and that they are making progress.
No words or explanation can replace the picture when giving a report to a patient. I have found that patients’ interest and attention go way up when viewing a report of findings and that doctor’s find it easier to communicate the information to the patient.
The future of chiropractic care
Diagnostics provide biomechanical information to identify the problem, educate the patient, and prescribe the right treatment plan. Arguably, every patient should go through a biomechanical exam, including digital foot scan and standing X-rays.
All of these diagnostic findings are relevant to a patient’s musculoskeletal health now and in the future. Everyone goes to the dentist to care for their teeth; why shouldn’t the musculoskeletal system receive the same level of consideration? Think of the abuse, accidents, bad habits, poor conditioning, and weight issues that your patients’ bodies go through on a regular basis.
In most cases, people don’t get their musculoskeletal system examined until they’re injured. The doctors who are seeing most of these patients know virtually nothing about musculoskeletal issues or biomechanics. They focus on providing adequate pain relief with medications (including opioids). These medical providers are masking the symptoms and not treating the problem.
Chiropractors are the answer to the musculoskeletal health crisis. We are the largest non-drug profession and the most qualified to care for the musculoskeletal system. However, we must start with the facts and use foot scans, X-rays, and MRIs to get an accurate picture of the patient’s musculoskeletal health.
Tim Maggs, DC, has been in practice nearly 40 years, and is the developer of the Concerned Parents of Young Athletes (CPOYA) network, with the goal of offering every middle and high school athlete a biomechanical exam prior to each sports season. The network, in partnership with Foot Levelers, provides training, resources, networking opportunities, and more for DCs interested in working with youth athletes. Maggs can be contacted at firstname.lastname@example.org or through CPOYA.com.