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Thank you everybody for joining us for this week's MD referral program Webinar. This will also be recorded and posted in the audio video library. And additionally this will be broadcast in or on the podcast channel for members only, which is the private channel. If you don't have access to that, you would have received an invite email. Um, if you need access to that, let me know. That's the science of Chiropractic. You can log into that directly using podbean.com or you can use the Podbean App, which is probably the best way that'll give you the ability to use it on your phone when you're running or you do paperwork at the office, et Cetera, et cetera. And we're also going to have these transcribed into text format. That way if you like to sit and read, you can do that. But I'm trying to bring all of this content into as many different media formats as possible because everybody's a little bit different. 

Um, I know I like video, but I also like audio and then there's times I just want to read as well. So you'll see all those formats. Um, I did hire an employee that's helping me with all this stuff now, K ate, so you're going to see a lot of this stuff get organized a lot quicker. Uh, there have been some, uh, new members of the program that have really sort of taken me to task to get better organized and create a, a beginning pathway that leads up to the top. Now I see barriers on your, uh, I'd like to congratulate Dr Hitchcock a, he is practicing in Athens, Georgia very just secured a rotation of medical residents, uh, through his practice. So, um, that's a very, very exciting time for him and his practice. So congratulations on that. 

All right, so congratulations. Very, um, with that being said, let us look today at. I'm really, I, I think I would call it, um, introduction to introduction to spinal biomechanics. Now when we talk about this, what I'm really sort of interested in all in all aspects, right? You know, clinical care and patient care is, is what we do. And it should always be at the forefront of our mind, but I don't really want to waste time learning anything unless it's also going to bring patients into my practice, build relationships in the medical and the legal communities and overall, you know, build the value and income of my practice. And that's the same thing that I want for you guys. So when it comes to spinal biomechanics and very basically 

we want to start with the concept of pain right now we could have a lot of philosophical arguments about whether we treat pain at all, whether we care about pain, pain is the last thing to show up, and the first thing to leave. Like we could go on and on and on with all that I get it. But when it comes to kind of connecting and communicating with the medical community, pain is a very important aspect. Okay. In fact, there's now right? Pain management, there's an entire division of medicine that is there to manage pain or they never talk about curing pain. It's pain management. So they're really sort of admitting that pain is a progressive, potentially progressive process in the body and it's not cured, it has to be managed, but from a spine biomechanical aspect, we know that we cure that all the time. So when we're talking to the surgeon, and this is, um, specifically related to the spine surgeon and we know when we work with a surgeon, we can use a neurosurgeon or Ortho is long 

as they had a neuro surgical fellowship or they've trained at that level. Okay. I do like working with orthopedic Spine surgeons with those credentials, um, because um, because they really understand what we do. The Ortho is really approach everything from a biomechanical engineering perspective. So it's very easy to communicate with them. But when it comes to spine pain, there's two aspects that we're really concerned about. And this is, this is really what I'm discussing with the surgeon. Okay. And it's a discussion, it's not me teaching or preaching, but there's two aspects of spine pain that we have to be concerned about. The first is the anatomical, and the second is the biomechanical or just simply 

mechanical. Okay. Now, when it comes to bio, mechanical or mechanical, the medical community also calls this nonspecific, which correlates directly to this here, that there's no specific anatomical component to the pain, so it's not specific and this all stemmed from the basic fact or the basic idea that maddix review the spine as an anatomical structure more than they view it as a functional structure or a functional organ system. And when we talk about anatomical reasons or causes of pain, we have, you know, the bad ones, fracture, um, tumor infection. But we also have herniated nucleus pulposus a degenerative disc disease. Um, and then there's, there's others, right? But these are the main ones. Some of these anatomically can be absolute contra indications and some can be relative contra indications, right? Somebody with an infection or a fracture is going to be an absolute contraindication and it's just good patient care to get the that patient to where they need to go. 

You know, herniated disc, disc, extrusions, degenerative disc, this disc disease are all relative. Contra indications, which means that depending on the degree, depending on where they're located, depending on prior treatment, there's a lot of things that depend on whether or not we would provide treatment. So relatively speaking we could treat them or we couldn't. Absolute is that there's no question. So we all know this. This is really where our diagnostic training comes into play. Okay? And this could even be, we could probably even add, um, concussion, you know, or a, uh, an anatomical cause of headache, you know, a Chiari malformation, etc. But that, this is really where I teach doctors.com comes in. This is going to give you that Background in order to be a better diagnostician for anatomical issues. Now I'm very much importantly, if you're not coming, if you're not registered yet, you really have to think twice about registering for the october seven. 

You know, this is going to be some of the biggest things that mark and I have been working towards for a very, very long time. We're all going to come to a head in this and we're going to plan out the next year. So, um, it's gonna be very difficult for us to translate. I mean we have friday, saturday, and sunday this year, so It's going to be almost 20 hours of lecture that's going to be very difficult for us to communicate to people in an email or a podcast or whatever. It's a lot. So I'm planning on being there. Please. Now, when it comes to communicating with the surgeon, hey, the first thing that they're concerned about is whether or not you have the aptitude and the expertise to understand the anatomical component of spine pain. That's where they spend all of their time and that's where the diagnosis, a diagnostic skills come into play. 

They don't want you to miss anything. They have to have confidence that when they send somebody to you or they're working with you on cases that you know, your triage and your discussion really is anatomical first. That's what we're concerned about. Hey, the bad stuff, the bad stuff that if you were to treat that patient, you'd, you'd be in trouble. Or if you missed something and didn't diagnose it, failure to diagnosis a big thing. Okay? And because most chiropractors aren't in a position to show that they have those extra diagnostic skills, particularly through the cv or conversations, most chiropractors don't have training in mri or any of those things. So those are the things that you use in order to get across to the surgeon that you're very well educated in identifying anatomical causes of pain. That's easy, that's, you know, that that's part of that process. but what the surgeon doesn't really understand or take into consideration is this sort of nonspecific mechanical pain. The number one thing that will always surprise surgeons when it comes to biomechanical. Because remember, for them, this is an enigma or I mean they don't have interest in the mechanical spine side for two reasons. One is these aren't surgical. 

One second. Hang on one second. Okay. Um, they're not surgical. So the surgeon really doesn't give a crap to be perfectly honest. And secondly, it's not in their eyes. If this is even a word, it's not objectifiable. Okay? So just like an anatomical consideration. okay, we can tell a fracture. We can objectify that right way. We can say an x ray tumor. We can do an mri, we can do an x ray infection, we can take blood, right, herniated disc, degenerative disc disease, concussions coming around, but these are all things that can be verified. I can take these pictures and I can show somebody you have spinal cord compression. Okay. It's not way we think it's spinal cord compression. We can actually see the darn picture. Right? That's not the case with biomechanical in medical, in medical science, in medicines world, there are not functioning type of doctors. 

They're very structurally oriented. Okay, so this would be something out of this pot side. On the anatomical site is the structural and the biomechanical side is the function. So thiNk about it in gross anatomy laboratory session. Okay. when I was with the medical students, a couple of them, like last month, this discussion I had with them, everybody in that lab, everybody literally body in that lab for the most part will look the same. Right? And we all remember being in there and when somebody had an anomaly or something different, we all crowded around that body to learn and that's what medicine focuses on. It wants a rigid structure. We look at the structure of blood, we look at the structure of the human anatomy in the spine and we're looking for changes in structure. Okay, but what happens when there's a functional component overlying, right? We understand that pharmacy really, truly in medicine. 

Pharmacy is the part of medicine that handles function. So think about this. If you have a structural change in your blood, you have too few red blood cells, gay, you have anemia. Well, what's the structural problem with that? Well, we have fatigue, we have low oxygen, we have all these different components to the symptoms. So functionally we have a result, a result in deficiency and function because we have a structural problem, we're not getting enough on you're. We're not getting enough b 12, so the body's not making enough red blood cells. So there's a chemical or drug or supplement or something chemically that can be given to influence the structure and that's the basis of almost all of madison and it works pretty well, you know, give or take a philosophical argument for most systems in the body that you can have a compound or a chemical that changes the function which were there for how make the structure more efficient or back to normal. 

That works in almost every body system except for the spine. Okay. There's no drug for a mechanical problem. You can't give the patient a pill to fix an anterior pelvis or a new tated sacred or functional short leg. There's, there's no pill, there is no chemical. The way that you restore function in the spine pain patient is through hands on chiropractic adjustment. Okay. That's why madison in general and surgery specifically has such a problem with the function because they're never taught it because there's no pharmaceutical solution, which is the basis of most of medicine. Right? So because it's not a surgical case, they can't really objectify it. And I would put this down here, three, there is no pill for it. We really see. And by and large, why functional? The functional aspect of spine care was pretty much discounted, has been pretty much this concept. Okay, so let's take a. Let's clear this out. Okay. So let's talk about function with the surgeon. 

There's a couple major premises to the functional aspect of the human spine. Okay. We need to know what's normal. Actually, we want to consider optimal. There's no such thing as a normal spine too. We want to understand when, what happens when the spine becomes abnormal, then we want to show how we, how we objectify it. Okay. How do we show, how do we show pre and post that what we did help? All right, so when it comes to normal or optimal, this is the key, right? So when you're talking with the surgeon, we want to talk about normal function is balance. 

The number one way that surgeons right now can articulate or they discuss balance is in the sagittal plane. So this is lordosis, kyphosis, and that's in the cervical and lumbar spine, mostly right in the thoracic spine, but there's influence as one increases or decreases. So do the others. The thing that we've not looked at functionally, which is just starting to come out, is we have to consider the entire spine, one organ system. We have a whole spine model, so when we look at an optimal spine, we're looking at sagittal plane imbalance of lordosis, kyphosis, but we also look at this gloating. Now again, this is not a discussion scientifically about chiropractic and all the things that we may or may not do to the spine because remember, the thing that makes the spine you need is the coupled motion. Okay? With bending, you get rotation. 

That's unique to the spine. The surgical community is not there yet. They're still in the sagittal balance aspect and they're moving from say, lumbar lordosis into looking at the influence Of it started with the pelvis. Let me back up. So it was pelvic incidence. okay. Which abbreviated is pi. Okay. If you go on the md referral program site and you log in, if you go to the video library and just type in pelvic incidence in the search bar, it'll show you that video and that'll explain it and what the normal parameters where this was published years ago, but it was a start, right? They all looked at the pelvis. Then theY looked at the lumbar spine. Then they look at the relationship of the lumbar lordosis, the kyphosis in the thoracic spine, and the lord says in the cervical spine, so the research is going from the bottom up and we're very close to this whole spine model and that's why it's really critical for every one of you to find a surgeon to have these conversations with because every surgeon is going to be using a chiropractor at a very high level in a very short period of time because they don't want to do any of this. 

Physical therapists can't do any of this because they can't operate autonomously. They can't order mri's, they can't order x rays. They, you know, they're not going to assess the patient off of an x ray. They have to continually operate under the umbrella of the surgeon and that doesn't help the surgeon. So when we look at abnormal, all we're doing is looking and we're talking about an unbalanced spine, we have abnormal disclosing and we have an increase or decrease in either the lordosis, kyphosis or both. Maybe we have lateral curvature, um, you know, in the case of scoliosis, etc. Etc. But the biggest thing is disclosing and compensation. So when the spine has an abnormal configuration, right? Generally speaking, it's due to spinal compensation and that's done through or that occurs through the various daily activities, maybe an injury, anything compensate immediately or it can compensate slowly over time. 

But when you listen to Dr. Wiggins work on the friday of the seminar, okay, he's going to have a half a day just to go through hIs stuff. The science shows that the spine only compensates in a predictable pattern and it uses the phases of gait to do that pelvic tilt, torso rotation, et cetera, et cetera. So, well, how do we objectify it? There's really only two ways. Okay. No, there's three I should say. Okay. We could do. I'm a three d live assessment, which is gait and posture, which we all do. Okay. That's the easy one. The second m is just visually we look at an x ray. We can see the cervical spine. Okay. We got the head here and we have a straight cervical spine. We have the head here. We have a reverse curve of the cervical spine, etc. Etc. Right? So all of these things show objectification of spinal, of abnormal spinal compensation, which is important to us and the surgeon and the patient because that leads to changes in the sagittal balance or sagittal plane which causes abnormal disclosing, which then produces pain. 

Okay. When you have spinal compensation changes in sagittal balance and abnormal disclosing, leading to pain without a specific anatomical reason for that. That is mechanical spine pain. That is nonspecific spine pain. That's bio mechanical spine pain. That's chiropractics world. Okay, so the idea that we have to do anything else as chiropractors besides be who are who we are to be busier than ever is right around the corner where they're. Okay, and I've always said this, that chiropractic isn't going to validate chiropractic medicine is going to be and believe me, maddix don't want to have anything to do with this. They Want to have a place to put in refer these patients, which is a really, really exciting time, but it's most important when we're communicating with the md that we objectify the problem. Okay? And we use red gate posture. We use x ray analysis or we use visual x ray. 

So let's just call this x ray and visual underneath here and if you're listening to this on a podcast, it's because I'm writing on a whiteboard, but um, you know, we're basically discussing everything that we're doing. So x ray, we can do it visually or we can do x ray and we can digitize the acs rate digital analysis, which is the same way that gonstead and logan and all of the doctors before us that discovered and created techniques, acts, re digitization or a measure issue. This is the key when you need to assess coupled motion, okay? This is the only way to get both sagittal and rotation all in the same aspect. Okay. That is real weekends work. This is a reimbursable test. Alright. We do it at our office and we built for it and it's a process for us because does everybody that comes in get it? 

No, because most people. I can do a three d gate analysis posture. We can do some orthopedic tasks, we can look at and we can adjust them. They get better, they balance out, but then there's the people that come in, they're contemplating surgery, they've been to other chiropractors before they bend the massage, they've been to acupuncture. What they need is a deliberate and a very detailed diagnosis, a functional biomechanical diagnosis. So let's take a look here. Kind of coming in for a landing. What we're ultimately going to say to the surgeon, okay, there's two types of spine pain, right? We know there's anatomical and biomechanical. Anatomical is the surgical world, and you can give examples of those disc herniations, fractures, etc. Biomechanical world is the cairo, but what the patient really needs is a an accurate diagnosis, prognosis and treatment plan. The Surgeon is looking for an accurate to per our to promote surgery. Okay, but what we're really looking for is a diagnosis of what the anatomical cause of this pain is. We also want an accurate diagnosis, prognosis and treatment plan for the biomechanical component, and that's chiropractic. So how does this in the end benefit the surgeon? Why do they give a crap? 

Very simply, you ask them one question, how do they know that they're not fusing a patient's spine under compensated position? How do they know that that vertebrae is in a proper biomechanical, a balanced position before they put the bolts in there, and the truth is they don't know the new and they know. I've known about this for a long time, but the reason that they never admitted because it was very difficult for them to objectify the biomechanical component. That's where we come in. So in the end, this is about in the cases that patients do need surgery, you actually want presurgical chiropractic care. We've always talked about postsurgical, but by the time you get in postsurgical, they're fused. You can't undo that, right? We got to undo the compensation before they buttress the anatomical problem, so when it comes to working with the surgeon and it comes to discussing spine pain, there's two aspects, anatomical and biomechanical. I tell them I am trained in the anatomical component of diagnosis so I can triage patients, I can see them, I can diagnose them, and then I could send them to you for console for surgery. Okay. we don't send to a surgeon for a diagnostic consultation. We send to a surgeon for a surgical consultation. here's my training. Here's my cv. Additionally, one oF the most common reasons that their spine pain is a biomechanical reason. 

That's my specialty and we diagnosed and objectifies scientifically. That's the keyword. I can scientifically objectify mechanical spine pain, and we do that through a Series of tests. It could be as simple as a gait analysis. It can be a little bit more complex and we could use x ray analysis and we could measure vectors or I can run it through a very complex software program that will show us not only sagittal balance, but it'll also show us coupled motion imbalances as well. That way we can really identify the loading on the deSk, whether it's abnormal or normal because they know, right. We've all had patients with five millimeter disc herniations that are perfectly functional. You have a patient with a six millimeter extrusion. That's fine, but I also have patients with two millimeter disc herniations that are not functional. It all has to do with the overlying biomechanical component. 

So you want to ask them how do they know that they're not using a compensated vertebrae? Did you know that I can objectify biomechanical problems and that these types of biomechanical problems are not cured. They need to be managed. Hey, that's the basic premise of working with the surgeon from a biomechanical perspective and other videos and podcasts. We're going to talk a lot more about the very, like the in depth stuff like the rate weekend stuff, like if the surgeon really is is interesting. Okay. But this is the sort of the preliminary discussion and we'll have a lot more to go. So does anybody. With that being said, anybody have any questions before we wrap up? Okay. All right. Very good. So look for this to be posted, sit, talk with your surgeon's, call me if you need to do some role playing, but I'm definitely here for you and have a great day. Thank you.

PLEASE TAKE NOTICE: © Copyright CMCS Management, Inc - Dr. Mark Studin 2015 - This information is intended for educational purposes only. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon is prohibited.