Academy of Chiropractic’s

MD Relationship Program


Clinical and Impairment Consultation 

From:  William J Owens Jr DC DAAMLP

Here are some common questions – Pleas read…thanks. 


I have a patient that I believe would be a candidate for this as well as potential impairment.  I watched the traumatic bulge video last week and my associate and I looked at one of our patients flexion extension film.  All his flexion is coming from C6/C7. 
I have questions: 
1.  Do I repeat the flexion – extension films at the end of care and measure at that time?  I assume yes – yes, in order for the impairment to be PERMANENT  it must be measured at MMI. 

2.  What if he is asymptomatic but when we repeat the films at the end of care there is still the asymmetrical loss of motion present?  Would he still qualify for an impairment if he has no pain or limitation in function? Yes, remember it is about the FUTURE harm and degeneration that occurs.  Most amputees are asymptomatic as well…

3.  Most flexion extension happen in the lower cervical spine, correct, as most rotation happens in the upper cervical spine?  So are we really expecting to see symmetrical balancing of flexion across all segments of the C-Spine on the flexion films?  (same for extension)  – YES – majority of rotation = C1/2

4.  I remember from the dinner seminar you saying less 11 degrees of segmental motion was impairment but in the webinar you saying something about 0.6mm was the threshold for impairment for angular.  What am I missing?  – .6mm = Ligament Injury, it has to reach a threshold of 3.5mm in CS or 4.5 in TS/LS in translation or > 11 degrees to be RATEABLE.  Just because you have a LAX LIGAMENT does not mean it is RATEBALE at 25% by the GUIDES. 

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