Static palpation is of obvious limited value and motion palpation, according to published studies, has a 50 percent interexaminer reliability factor. 1 Static plain film x-ray taken while the patient is upright can help determine the presence of pathology or gross distortion patterns of the spine. Doctors of chiropractic must make a giant leap, however, from the above examination procedures to a functional diagnosis of individual segments of the spine. Since 1989 this clinician has employed the use of two additional plain film radiographs depending on the level of interest, cervical, thoracic or lumbar AP right and left lateral flexion end point stress films. Still considered a static film, the film is taken at maximum end range while the patient is instructed to hold this position.
Patient position is critical for accurate assessments.
With the addition of these films and the static or neutral views of the patient, a more accurate diagnosis of segmental function can be made correlating physical exam procedures. Various authors, such as Adrian Grice, DC, and W.H. Kirkaldy-Willis, MD, have attempted to qualify types of aberrant segmental dysfunction of the lumbar spine with the use of lateral bending stress radiographs. 2-4 Chiropractic clinicians Bergman, Speiser, Vahl et al., have published papers suggesting the value of using functional stress bending films to diagnose segmental dysfunction and to improve therapeutic interventions. Clinical Chiropractic demonstrates how lateral flexion views of the cervical and thoracic spine can be used to diagnose segmental dysfunction. An obvious concern when taking additional radiographs is the increased patient exposure to ionizing radiation.