Evidence-based chiropractors explain the disconnect between symptoms and imaging findings.
Recently, Daimon K et al. (2018) published a landmark study for EVERY evidence-based chiropractor. It highlights the notion that degenerative changes are merely age-related and do not necessarily correlate with symptoms. This study assimilates two decades of sequential imaging to prove that there little association between degeneration and clinical symptoms:
“results of our statistical analysis and the different rates of disc degeneration versus clinical symptoms reported here and elsewhere, the degenerative findings on cervical MRI do not appear to be generally associated with the development of clinical symptoms.” (1)
Structural findings take months or years to progress. Acute symptoms usually occur within moments to days after a trauma, or change in activity, movement, hobby, or habit. Structural abnormalities can complicate tissue failure, but are not directly correlated with symptoms. It is essential that we focus on what is correctable and what is not. There is no treatment to eliminate the degenerative changes in the spine; however evidence-based chiropractic care can effectively and efficiently resolve symptoms.
Arthritic and degenerative changes are a fact of life. It is important not to focus on what shows up on imaging but rather focus on what we can do with the cards that were dealt.
“the rate of degenerative progression at one intervertebral disc level on MRI over the 20-year period was 95.3%, whereas the rate of the development of clinical symptoms was 66.9%. Statistical analysis of the relationship between the progression of the 5 degenerative findings in the cervical spine and the occurrence of clinical symptoms only detected a significant association between foraminal stenosis and upper limb pain.”
When a patient presents with a one-week onset of neck pain; is it from their stenosis? NO! The cervical narrowing has been there for years. Is it a complicating factor? YES. We treat the patient’s symptoms by focusing on the functional reasons the pain started. Once the pain is gone, the stenosis will still be there. Our office educates the patient to not blame their arthritis for every malady affecting their life. We focus on their habits, hobbies, and postures to eliminate the stressors on their body that are exacerbating their spinal condition. This same paradigm works for disc pathology, or chronic meniscus injuries, or SLAP lesions, or…(name your chronic structural lesion)
“A study of clinical symptoms and cervical MRI findings by Siivola et al. showed that neck and shoulder pain in young adults was not associated with disc degeneration, an annular tear, or disc protrusion on MRI.”(2)
Cliff Atwell, B.S., D.C.