In Ontario the government has recently pumped a lot of money into new CT scanners and MRI machines. These machines are very useful in diagnosing a whole host of conditions, and this move tells you a little bit about the direction medicine is taking. While they do assist the MDs in their diagnoses, and in some cases are indispensable (brain tumors), they have their downsides too (the costs being the major one). One downside is of particular concern to chiropractors.
I wonder about the increasing reliance on these “snapshots”. MRIs, CTs and X-rays are really snapshots of your insides. Of course, a picture is worth a thousand words, and these give you all the information any snapshot would: How big, what shape, what’s it pushing up against, is it torn? That information is very helpful for a pathology – a tumor, a herniated disc or a compression fracture.
But what are they missing? What do snapshots not show you? Well, that snapshot of Uncle Jim walking across the yard doesn’t show you his limp. Or his stutter. Or the way he doesn’t move his arms when he walks. He looks quite normal in the snapshot but actually stands out like a sore thumb at parties! Especially on the dance floor.
Snapshots don’t show you function, how well the parts you see are working. So often I take an X-ray and find it’s absolutely normal even though the person is in great pain. The “normal” joint is jamming with every step!
This, obviously, is of great concern to chiropractors. Function is what we treat. Mechanical problems often are entirely functional problems. The parts are all there but they’re not working right. Getting them working right is our job.
Then there are the MRIs that show bulging discs in the low back. Well, there’s the problem, you’re told, we can see it right on the picture. I’m afraid that’s not always the case. A careful examination sometimes shows there’s more to it than that and the disc issues may be not the problem at all. A jamming facet joint in the spine can be over looked by the red herring of a minor circumferential disc bulge. Relying on “snapshots” can lead to misdiagnoses. It’s easy to do. By middle age more people than not have discs that are showing their age and bulging a little, but not causing pain. For a chiropractor that’s a sign to look closely for mechanical problems, the joint stiffness that develops as the body tries to compensate for or guard those stiff discs.
So, if you have back or neck pain, don’t just rely on a “snapshot” for a diagnosis. Make sure whoever you see is looking for your ”limp” too.