In this series we will consider only APPROPRIATE DIAGNOSIS AND DELIVERY aside from therapeutic advantages of the ACCEL monitored therapies:
Any therapy is only as effective as the diagnosis which drives it. Recent research has indicated MRI oddities are discoverable in 64% of the pain-free population! My experience has been that anyone over 21 years old exhibits oddities on plain film X-rays too! Ultrasound soft tissue scan by pin-point imaging of deep soft tissue inflamed sites verses "cool-calm" sites can differentiate X-ray or MRI oddities which are cool and calm (probably old and settled and of little consequence) from inflamed oddities (your body is trying to repair the area) which are highly probable for cause of pain. *( However, intelligent correlation of all tests is the real core since like every rule this general "rule" has exceptions, see "NOTES" below )
STEP #1 is accurate diagnosis:
For example: For Sciatica patients, especially those who have been to other doctors without relief, we must be open and ask: Is the cause the spine, an anomaly or defect, the vertebrae inter-positionings (subluxations), the facets, the disc, the nerve tunnel, the near spine, the sacro-iliac, the hip bursa, a muscle, the knee, the ankle, a tumor, a cyst, an infectious cyst, or small adhesions all along the course of the nerve? (Sometimes too, the answer is YES it is many/ALL of the above.) Ultrasound scan under Institute orthopedic protocols with ability to detect inflammation signs (micro-lymph dilation and hyperechogenicity) is the best tool for diagnosing whether a given possible area of involvement is actually involved in the sciatic noxious stress loading.
STEP #2 is devising an appropriate treatment plan:
The easiest practice style involves using ultrasound scan technology to watch the results of therapies administered so the treatment plan can be verified as "effective" or "ineffective needing change" day by day. My experience is that although general therapy guidelines can be employed to plan, every patient is a little unique, and nothing is superior to "Seeing is Believing Practice Style" (tm). { Electrical therapy is a good example: Our research involving deep tissue observations reveals some patients reach optimum reaction in 32 seconds others optimize in 12 minutes. Assumptive standards which apply 5 minutes to everyone are apriori inferior to "Seeing is Believing" efficiency: Key finding: Treating past the optimum point drives patients into sub-optimum tissue reactions or exacerbative reactions.}
NOTES: (Exceptions to the rules:) Although I teach my students to "avoid waking up the sleeping grizzly bear", since an old condition once disturbed can lead to new problems and prolonged care as I mentioned above, there are exceptions to every rule, thus I REPEAT, intelligent correlation of all test results is the real key to a doctor's success and the patient's hope for relief.
*Exception: #1:
Certain ACTUAL HERNIATIONS OF DISC seem to act as a vertebral column stress release mechanism: If older than three months these areas can appear quite cool and calm on the ultrasound scan. If MRI reveals actual disc material to nerve sheath or thecal sac depression-contact then in these cases pain symptoms and MRI definitive findings must alter the implications of the ultrasound negative findings:
The nerve trunk itself however usually remains inflamed, however a surrounding and supporting para-spinal inflammation "field" is usually absent. In these instances the "cool-calm" ultrasound findings and definitive MRI findings when correlated mean the body has "given up" on repair attempts and there is little hope for non-surgical resolution.
*Exception: #2
If MRI is negative (no thecal sac depression or sheath contact) or uncertain and the ultrasound findings reveal inflammatory signs AND the patient only has pain in certain postures then sports X-ray views may be indicated to confirm the ultrasound findings. The MRI is usually a recumbant test, unless the patient has pain when laying down the MRI is unlikely to reveal the cause of pain for a patient who has pain only in a certain standing or bending posture, BUT NO PAIN LYING DOWN and thus no signs on MRI when laying down. These type situations will probably show no MRI discernible disc problem when lying down for the MRI (especially true if Valium has to be administered due to claustrophobia - it relaxes the muscles even more and thus further relieves pressure on the disc ). My name for this syndrome is the "Peek a Boo Disc Syndrome". Sports X-ray views taken neutral standing A/P and Lat. and then bending to pain point A/P and Lat usually can confirm a very odd motion or two of the vertebrae, and thus by inference and correlated to the ultrasound signs of inflammatory activity, " intermittant disc bulge" is the diagnosis. ( X-ray signs to look for are flexion of two vertebrae during general extension or vice-versa, and/or anteriorad or posteriorad listhetic off-set motions ).
Another variant on this "sports views indicated" theme is the patient who complains of pain only under certain stresses. An example would be the weight lifter who has pain when lifting 100 Lbs. in a "press" motion. Be creative and take X-rays neutral no stress verses neutral lifting the barbells to the pain point. Disc compression is usually measureable with implications for "peek a boo" bulge.
Politics & Peace:
The tension between Medical Doctors and Doctors of Chiropractic involving significant "subluxations" and insignificant "subluxations" can finally be resolved. Unless the patient's reflex and immune systems are completely exhuasted (a pre-fatal state of affairs rarely seen in the average simple spine pain patient) the patient's healing reflexes will be launching inflammation, protective muscle spasms, and Wolf's Law reactions in the stressed ligaments and tendons if the slight out of placedness (subluxation) is fresh (acute/sub-acute) and even sometimes years after the original injury some activity will be obvious on ultrasound scan. In these cases of body cellular level distress there can be no question that the "subluxation" is significant and probability is high for a need for care. Since the Doctor of Chiropractic has studied years and may also have years of experience in reducing these subluxations the therapy of choice is obvious as well as the therapist of choice once ultrasound soft tissue scan defines those "slight out of placednesses" which represent significant NOW TIME subluxations. Ultrasound scan can also assure everyone involved that the task of reduction has been partially or fully accomplished on a daily post treatment basis. (Sub-acute to chronic situations may require repeated applications with associated muscle tone strengthening in a full rehab milieu since habits form quite rapidly during the induction phase.) Reversal of the stress related "subluxation habit" may require repeated "training lessons" via manual adjustments until new refreshed healthy reflexes establish the habit of "dynamic stability", PLUS rehab exercises may be required.
Summation:
For diagnostic purposes ultrasound soft tissue ortho scan offers the following health care market opening advantages:
Super accurate diagnosis: (Ability to effectively work up treatment plans for formerly hopeless pain patients. A new market segment. )
Interprofessional scientific harmony and the ability to amalgamate a common terminology: (Potential for harmonious interdisciplinary teams.)