Part 2- A more in-depth look at reading X-Rays

In the last blog article I explained the various reasons we use X-Rays as tools for evaluation as well as the basic outline on what we look for when looking at your X-rays. In this particular blog article I want to explain what we can determine from a chiropractic point of view from films.

What is more interesting from a Chiropractic Evaluation is the specific position of each vertebra.
When a vertebra is out of position it shifts and tilts FORWARDS a small amount, this needs to be corrected with a specific adjustment. From the forward position it can tilt sideways as well so that these vertebra can initiate sideways curves or scoliosis and a set of compensations that lead to muscle tension and further injury.

Using films to explain the concept.

Lateral view:

In this lateral view,  the last lumbar vertebra (L5) and the next up (L4) tilt and shift forward. We still need to stand upright so they cause  L3 and L2 to hyper-extend and this causes an  increase in the lumbar lordosis.

The sacrum also extends backwards due to the change in orientation of L5. Due to the hyper-extended position of L2,  the thoracic spine Vertebrae need to flex forwards until they tilt and collapse forwards eventually leading to wedging of the vertebral bodies.

                                                                                                                                                              

The forward view:

The vertical lines show the curve that is initiated at L5 with L4 following it.
The lateral lines show how the pelvis has compensated and how a change in leg length would be caused.

What are they feeling?
These injuries should have been caused by some sort of trauma, postural or an accident. If the spine is going left the muscles would be strained and painful on the right from trying to hold the body up.
The change in direction from left to right at L3/4 would cause Joint pain on the right from the compression of that joint. Disc compression at L3/4, the rounded surface of the bottom of the L3 vertebral body shows this as the disc has been pressing upwards due to the hyper extend position.  The shadows of the Iliopsoas muscles indicates muscle tension and a forwards pull on the spine that would cause the gluteal muscles to deactivate, the hip muscles would have to take over and become fatigued and sore over time.
Based on the spine position this person should have chronic muscle tension and hip pain with acute flare ups of central low back pain and hip pain with exertion.

How to fix it?
Lifting the L5 and then L4 Vertebrae and correcting the Pelvic position would make the muscles function better and correction of the pelvic position would facilitate this further.
The improved positions of the lower vertebrae would remove the need for the upper compensations.
The thoracic spine vertebrae that have tilted forwards can then be corrected and specific rehabilitation can be done teach the correct muscles to work at the correct time.

If you have a set of x-rays that you would like to discuss or if you have any questions regarding this article please give me a call to discuss that.

How I read X-Rays

The next series of articles will be about reading  X-rays. These are the basics and the follow up will be more in-depth. X-rays are a quick and easy tool for me to be able to get a good idea of what is going on in the spine. You may want to refer to my article on anatomy for a better idea about the structures being described.

 

There are specific criteria for Spinal X-ray/ Diagnostic evaluation: They are as follows:

• Traumatic injuries especially those with a dangerous mechanism of injury, fracture risks with low bone density, 

• Neurological signs and symptoms such as radicular pain or muscle weakness

• Persons who don't progress and heal as expected are also sent for diagnostic imaging. 

The classic way to read a spinal X-ray is to look at the ABCD, that is the Alignment, quality of the Bone, the Cartilage and joints and the Dense soft tissue.  I'll show a few X-rays and comment on them to show what can be seen. 

 

As a basic evaluation:

 

Alignment: 

Are the vertebrae stacked neatly on top of each other?

Is there a curvature or scoliosis?

Bone

The quality of the bone, fractures, bony outgrows and signs of injury are examined.

Cartilage and Joints

Are the joints symmetrical, are they close together indicating a loss of disc height or a loss or cartilage, are there signs of arthritis or stenosis?

Dense Soft Tissue

Spamming Muscles can become visible, thickening of ligaments, metastatic tissue, visceral spaces, signs of bleeding show up on X-ray. 

The follow up article I will be giving more of a chiropractic evaluation and discussing these films with you.

If you have a set of films you would like to discuss or if you have any questions regarding this article, please give me a call or leave a comment.