Structural Management- X-Ray Protocol

Based on the premise that human beings are architectural structures influenced by gravity and many other daily stresses, combined with the fact that all of us are continually aging and many of us have suffered with multiple neuro-musculo-skeletal injuries, it makes sense to use the status of a patient’s structure before recommendations can be made. Secondly, every other valued asset a person owns is critically managed, such as their car, their house, their finances, etc. The thought that the human structure is only considered during a time of crisis is illogical. Using symptomatic elimination as our treatment goal ignores the very laws of nature with regard to preservation and health. If members of society knew they could preserve and slow down the degenerative changes of their structures, as well as maintain a higher level of function over the course of their lifetime, most would anxiously ask “Where do I need to go and what will it cost?”

Therein lies the need for Structural Management-.

A person’s structural status is based on age, prior injuries, genetics, conditioning, job, shoes worn, mattress used, diet, height, weight and many more contributing factors. Regardless of the symptomatic picture that exists, a standard X-ray series is performed on each patient. The three reasons for X-raying each patient is to 1) rule out pathology, 2) determine biomechanical defects, and 3) to show the patient for improved communication and understanding. If additional X-rays are required, it is up to the practitioner to make that decision.

The Structural Fingerprint Exam (X-Ray Component)

A four-view series is taken on every patient to determine the status and biomechanical imbalances from which all people suffer. These views consist of an A-P open mouth view, a lateral cervical view, an A-P L-S view and a lateral L-S view. All are performed in the standing position with shoes off. If the patient is in a distorted postural position due to spasms or any other condition, then only the area of involvement is X-rayed, with further X-rays taken at a later, more appropriate date.

A-P Open Mouth

Biomechanical measurements and interpretation:

1. Alignment of odontoid process with sp of C2
2. Equal atlanto-axial joint spaces
3. Equal atlanto-odontoid spaces
4. Balance of occiput with the spine

The abnormal views show imbalances in the atlanto-odontoid spaces, the relationship between the occiput and the spine and the rotation of the axis relative to the atlas. Any of these findings predictably produce an elevated irritation of the spinal column at the highest level. This finding is impossible to quantify, but as chiropractors, we all agree that the “normal” X-ray is preferred over the “abnormal” X-ray, and the health of the individual with the “normal” X-ray is predictably better (all other factors being equal). The goal in this case should be an improved occipital-atlanto-axial relationship.

Lateral Cervical

Biomechanical measurements and interpretation;

1. A lordotic curve for shock absorp-tion
2. The center of gravity (cervical gravity line) bisecting each bone so each bone can share in the distribution of the weight of the cranium (approx. 10% of body weight).
3. Healthy disc integrity

The abnormal views show a disruption (reversal) in the curvature of the neck, with the weight-bearing line falling anterior to the spine. This biomechanical imbalance predictably increases the stresses of the C5/6 and C6/7 joint space over time, encouraging increased demands and premature degenerative changes at those levels. There is also anterior bone growth with this type of biomechanical finding, which is a reflection of Wolff’s Law in action.

A-P L-S

Biomechanical measurements and interpretation;

1. Level iliac crests
2. Alignment between spine and symphysis pubes
3. Equal obturator foramen shape
4. Alignment of the spine

The abnormal views show an imbalance in crest heights, an unequal size of the obturator foramen, a misalignment between the spine and the symphysis pubes as well as a mass in the lower bowels potentially being a pathology.

Lateral L-S

Normal Abnormal Abnormal

Biomechanical measurements and interpretation:

1. Sacral Base Angle between 36°
2. Ferguson’s Gravity Line – the center of L3 bisecting the anterior 1/3 of the sacral base (center of gravity from the side)
3. Healthy disc integrity

The abnormal views show a decrease in the sacral base angle, a posterior Ferguson’s Gravity Line and a degeneration of L4, predictably an indication of an injury with inadequate rehabilitation rather than premature wear and tear which typically causes degeneration of L5 first.

Learn more about our x-rays at Nelson and Nelson by Contacting Us