Imaging 101

What is imaging?

When ”imaging” is ordered, it is in order to accurately picture structures within the body that you cannot otherwise see or feel.  Depending on what signs/symptoms are present, different types of imaging is ordered.  In the Chiropractic setting, most often, we will either want an x-ray or an MRI.

When would an x-ray or MRI be needed? Is one better than the other?

X-rays (radiographs) are only useful at determining bone structure. If we are suspicious of a fracture or break in a bone, then an x-ray will see it.  If we are concerned about arthritic/degenerative changes in a joint, an x-ray will give us an indication of the extent that the bone is involved.  X-rays are also useful in determining the degree to which a scoliosis is present. (By definition, a scoliosis is diagnosed by a curvature to the left or right exceeding 10 degrees)

An MRI on the other hand, clearly shows all structures within the body very well.  This includes bones, joint capsules, fluid, ligaments, tendons, muscles etc. An MRI in the Chiropractic setting is often used to determine the cause of nerve related pain (numbness, tingling, shooting pain) or if torn muscles or ligaments are suspected.

There are pros and cons to both: An MRI is the “gold standard” for imaging as it will show just about anything the provider could want to see.  This, however, comes at an increased financial cost.  X-rays are very quick and cheap however they do not show as much information.

Take for example, a degenerative or arthritic knee.  An x-ray could show that there are changes within the joint based on how the surface of the bone looks and confirm that there is indeed arthritis present.  It however will not show the meniscus, or cartilage within joint which typically is what’s causing the dysfunction or discomfort within the knee – an MRI would show all of that.

Should I expect to get an x-ray when going to the Chiropractor? Isn’t that how they know where to adjust?

Not necessarily.  At Eastridge, we will order x-rays if we are concerned about a bone problem i.e, fracture, dislocation, scoliosis, or moderate arthritis. Some Chiropractic offices will indeed take x-rays on virtually all patients and base their adjustments and treatment plans on those images.  This is an “old school” method of determining treatment.  The benefits of an x-ray have certain limitations and costs.  A major cost is unnecessary exposure to radiation (which is what an x-ray is) and is why the American Chiropractic Association has stopped recommending routine x-rays for patients.  A major limitation is how accurately an x-ray image will show “misalignments”.  If a patient is not in a 100% neutral position, then they could look as though they have hips that are uneven, a slight curve in their spine etc.  A patient could even have a very tight muscle on one side versus the other, which could show up as a misalignment but is in fact uneven muscle tension. Certain “misalignments” found on x-rays have been shown repeatedly to be un-reproducible on follow up imaging studies: which is a major issue when relied upon for Chiropractic treatment.

At Eastridge, we focus on function to determine an appropriate treatment plan and base our adjustments on what we feel and how the patient is moving in front of us.  We will push on joints to see which ones aren’t moving as well or perform orthopedic tests to reproduce a patient’s complaint.  This exposes the patient to no unnecessary radiation and allows us to find regions that are functionally problematic on any given day.

Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropr Man Therap. 2018 Nov 21;26:48. doi: 10.1186/s12998-018-0217-8. PMID: 30479744; PMCID: PMC6247638.

So... What exactly is the "pop"?

First, not all pops are created equal!  Sometimes we’ll crack our knuckles, or if we squat down our hips or knees will crack.  These types of “pops” are typically tendons snapping over a bony structure which causes a noise.  If this is happening, it is usually painless and able to recur on demand.  Ask your doctor how to reduce the frequency of this occurrence!

When someone receives an adjustment from a Chiropractor, they will also typically hear a “pop”. This noise comes from what’s called a cavitation which is rapid gas release and exchange within a joint. These “pops” will only happen once in about every 20 minutes or so when the gas perfuses back into the joint space. When you are receiving an adjustment, the Chiropractor is freeing up movement that is restricted within a joint or series of joints. The adjustment happens within what is called the paraphysiological space.

—Active range of motion: How far you can move your joints on your own (looking over your shoulder).

—Passive range of motion: How far your joints can move with assistance. (You’re relaxed, someone turns your head for you).

Let’s say you woke up on your stomach after a long night of sleep.  You obviously cannot breathe with your face square in the middle of the pillow, so you have to turn your head to the side.  Well, your neck has now been fully rotated to the right or left for 6-8 hours.  Since they have been in that position for so long, the joint capsule and tissues surrounding it restrict that joint from moving as much as it should.  This is where a Chiropractor comes in.  They will identify the restricted segment, and adjust it which takes the joint into the paraphysiological space, cavitates, resets the mechanoreceptors (which tell the joint where it is in space) and now you can move your neck easier and without as much pain! 

“I have my dog walk on my back and cause it to pop, is that doing the same thing?”  

-Nope! When you willy nilly “pop” regions of your spine, it most likely is relieving for a certain period of time. It just simply isn’t doing what you want it to do. When you feel as though you need to “pop” something, it’s because there is a joint restriction within that area. When you bend over backward over a chair, or have someone walk on your back they are “popping” areas that may not be the spot that need to be released and that “stuck” or painful feeling will come back rather quickly.

Imagine these two circled areas are where you feel like you want to “pop”.  You twist to the side and feel some cracks.  Those cracks you felt were not the joints that needed to be released because – you guessed it – they’re restricted!  The “pops” most likely came from the joints above or below the “stuck” area.  In order for these restricted joints to move as they should, a trained professional (i.e. Chiropractor) will need to step in to specifically manipulate those spots.  

To sum up, when you receive a Chiropractic adjustment or manipulation, your bones are not being smashed together or ”cracked”. The joints within the area of adjustment are being moved and freed from restriction which leads to a cavitation – the “popping” sound!

-Dr. Mat Mancuso

Eastridge Chiropractic has really big news

Patients of Eastridge Chiropractic,

It is with mixed emotions that I am announcing my retirement from chiropractic practice.  It has been a great pleasure providing for your health care needs over the past 21 years, and I thank you for your friendship and loyalty.  As I looked ahead to this transition, I hoped to find a talented chiropractor who will give the quality of care I have strived to maintain.

I am happy and excited to introduce to you Dr. Shantai Watson and Dr. Mathew Mancuso. They come to us as highly qualified chiropractors with very similar adjusting techniques and philosophy. They graduated together from Palmer College of Chiropractic West Campus in San Jose, CA in 2019. They have since been practicing in the South Denver area. Dr. Shantai has special training in prenatal, postpartum, pediatric and sports chiropractic. Dr. Mat’s expertise includes the care of auto, spinal and sports injuries, and he is skilled with rehab techniques and dry needling.

Dr. Shantai is originally from Edmonton, AB (another Canadian, like me) and is a second generation chiropractor. Dr. Mat has many stories from living all over North America, however he and his family have called Highlands Ranch home for the past 14 years. They love skiing, hiking, working out at the local CrossFit gym, and evenings spent snuggling their 1 year old Bernedoodle, Mabel, who you just might meet at the office.

I am very confident in their abilities and about placing your care in their hands. Dr. Shantai, Dr. Mat and I will be working together over the next month to make sure the transition is as smooth as possible and that your specific needs are met. Their techniques and general approach are similar to mine.

Please make it a point over the next month to come into the office and allow me the opportunity to introduce you to Dr. Shantai and Dr. Mat.

I sincerely appreciate the trust and confidence you have placed in me through the years. I wish you continued good health and all the best in the coming years.

- Dr. Jason McTavish , Dr. Shantai Watson & Dr. Mathew Mancuso