Spinal Decay and Phase Placement
Learn more about why we abandoned Subluxation Degeneration in favor of Spinal Decay.
Using X-ray views to "phase
place" a patient is a communication strategy designed to accomplish two important
tasks:
1. Help the patient acknowledge and "own" the
condition of their spine, and
2. Help the patient recognize that they've
had their problem for some time.
It is not used to scare
patients, justify a particular length of care or to manipulate them into accepting
a care plan of long term care! Of course, phase placement is only an option if
you take X-rays. The patient's "phase" cannot be determined by palpation,
the patient's age or other less invasive means. Before You See the Patient Effective
phase placement begins by assuming the proper headspace about the nature of spinal
decay revealed by radiographic views of the spine. Based upon several texts, including
Anatomico-Roentgenographic Studies of the Spine, by Lee A. Hadley, M.D.
and Managing Low Back Pain, by W. H. Kirkaldly-Willis and Thomas Bernard,
Jr., we make these assertions: 1. Structural changes to the
spine that are revealed by static X-ray are the result of neglected or uncorrected
mental, physical or chemical stresses to the body, and is not some "normal
aging process." 2. Like attempting to mend a broken bone, the body
senses the structural stresses and deposits calcium in an attempt to "splint"
the joint and stabilize it. 3. Pain or other obvious symptoms may or may
not be present. However, when brought to their attention, the patient may notice
reduce ranges of motion due to the loss of mobility in affected joint(s). 4.
The resulting degenerative process begins with abnormal motion or position of
spinal bones, associated soft tissue inflammation and nerve involvement (subluxation),
followed by changes in the architecture of affected vertebrae and calcification
of associated soft tissues until, given enough time, the affected joint(s) fuse
together. 5. This degenerative process (spinal decay) occurs in increasingly
worsening "phases" or stages. Because it is a process, whether one chooses
a three, four or five phase model, all are correct. (We recommend a three-phase
approach which makes the differences between each phase great enough for a lay
person to more readily recognize.) 6. It is impossible to predict what,
if any, effect chiropractic intervention will have in the slowing, stopping or
reversing of this degenerative process. Anecdotal observations seem to indicate
that appropriate care in the early phase of this process, especially when combined
with other forms of active care (exercises, maneuvers, cervical pillows, weights,
etc.) can produce curve restoration and functional improvement. In later phases,
it is hoped that appropriate chiropractic care can stop or at least slow the process.
7.
A particular phase does not correlate with a certain number of visits or
a length of time in which chiropractic care will be necessary. In other words,
it cannot be used to predict or justify care recommendations.
8. While it can be depicted as a four- or five-stage process, we prefer the three-phase approach because it makes the difference between each phase great enough that a lay person can see the distinctions.
It
is from this belief system that we make the following patient communication recommendations: In
Your X-ray Room  | Explain
your reasons for needing pictures of their spine, along with an explanation of
the fees involved and the safety precautions you take. Be sure to ask female patients
of the possibility of pregnancy.
Mount a copy of the Patient Media Spinal
Decay chart so the patient is directly facing it at the bucky when you set
up to take their lateral view(s).
With the patient facing the chart, here
is the suggested scripting: |
"Now, we're
going to take a picture of the side view of your neck."
Splay
your fingers on one hand, touching the patient's jaw, neck and shoulder. With
the other hand point to the top row of X-rays shown on the chart. "It
will most likely look like one of these. Either what we call 'textbook normal',
Phase one, Phase two or Phase three. In fact, when I show this picture to you
at your report, I'm going to have you compare it with one of these and tell me
which one comes closest to matching yours."
Repeat with
a similar scripting for any other lateral views you take. (For phase placement,
we find lateral views are the easiest for patients to see the key distinctions.)
At the Patient's Report Many
offices will mount a second copy of the Spinal Decay chart beside their X-ray
view box. When you get to the portion of your report in which you show
and review the films you've taken, it is helpful to first offer the patient some
orientation. (If you show our pre-report video, much of this is done for you.) | | |  | |
"This
is the side view of your neck we took yesterday. This is the jaw, this is your
skull, this is the top of your shoulder and these are the individual bones of
your neck. The black areas between them are the discs which separate each bone.
Notice the equal disk spacing the gentle, forward curve. "I'd like
you to compare yours with these, the textbook normal, phase one, phase two and
phase three. Which one comes closest to matching yours?"
Then
wait for the patient to respond. (It may seem like forever, but it's an important
opportunity for them to fully own their problem, rather than you rushing in a
supplying the answer.) There are only a couple of different patient responses.
Here are some ideas to make you more resourceful: Patient response #1:
The patient says, "I don't know." Our culture is so wrapped
up in "being right" and looking good, that many patients will be reluctant
to share their perceptions for fear of getting it wrong. In this case, an Anthony
Robbins technique may come in handy: "Well, if you did know, what which one do you think comes closest?"
This
can serve to give the patient "permission" to fail. The other
possibility is that of a patient in the Driver or Commander personality profile.
They resent having to play. In fact, their mentality may be "why-should-I-tell-you-after-all-I'm-paying-you-to-tell-me!"
Decide for yourself if it's worth forcing them to participate. Usually these efforts
are counterproductive. Patient response #2:
The patient overstates
their problem. Actually, this is quite common. Handle this correctly
so you don't make the patient wrong. Begin by congratulating them. "Wow,
good job! That's what I thought at first, but then I noticed ____ and ____ so
my conclusion was that we were looking at an early/late/mid Phase __. Do see what
I'm seeing?"
Patient response #3:
The patient
understates their problem. Again, be careful so you don't make them
wrong. As before, begin by congratulating them. "Wow, good
job! That's what I thought at first, but then I noticed ____ and ____ so my conclusion
was that we were looking at an early/late/mid Phase __. Do see what I'm seeing?"
Patient response #4:
The patient hits it dead on. For
sure, congratulate the patient this time! But be careful that it doesn't sound
like the "advanced Phase Two" they've identified is a good thing to
have happening in one's spine! "Good eye! Have you ever
considered becoming a chiropractor? Well, you are correct. So that means..."
Give
a quick rundown of potential neurological implications, how long they've had their
problem, why it may take a long time to correct, etc.
Repeat with any other
lateral views you've taken.
Go to the Spinal Decay Chart
Go to take home version we call the Spinal Decay Report Insert
| 
