We do get asked a lot by patients when they first come in, whether their spine is out of alignment. While there may be small deviations that have resulted in them experiencing back or neck pain to begin with, a lot of people can be told they have a scoliosis or another type of misalignment, by practitioners who have simply looked at the patient or who don’t have the capability of performing X-rays.
Judging a person’s alignment by just looking at them, especially judging that one shoulder is higher than the other, or one leg is longer than the other – without having X-ray proof often these findings can be completely inaccurate. Looking at someone’s posture as a judge of their alignment is really just scratching the surface of the health of their spine. In reality, especially if you’re a bigger person and not completely skin and bone, the way skin hangs over your body and taking into account the way your muscles hang over your body as well, this can be quite misleading as to how your alignment is positioned underneath.
Is An X-ray Or MRI Better For Measuring Alignment?
A lot of patients wonder whether an X-ray or an MRI is better for diagnosing their problem, and this is only natural since the normal progression of diagnostics under the NHS would be potentially initially having an X-ray followed by an MRI later, they are often thought of as a more useful type of imaging. To be the most helpful to the patient, it’s much better to have an image of the patient standing. In most cases when people come to us, it’s often a last resort meaning they’ve tried visiting their GP, perhaps they might have tried physiotherapy, injections, chiropractors etc. so we need to understand how exactly to treat them in the way that will get them the best results, and understand why their problem hasn’t resolved or responded well to treatment in the past.
To understand all of this, a standing image will give the most information – but a standing MRI is very difficult to do as you’ll have to be stood still for long periods of time – something that a lot of people with back pain may struggle to do. They’re also substantially more expensive – compared to standing X-rays which are relatively inexpensive, a snapshot is taken immediately and it clearly shows a patient’s alignment.
One of the most common misdiagnoses that can occur is distinguishing between an anterior pelvic tilt and a lordosis. The lordosis is the natural curve in the lumbar spine, it should have a backward bend to it around where your trousers or belt will sit. It’s common to have an increased or decreased curve In your lumbar spine – but just by looking at a patient, from the way their glutes hang over their spine and buttocks region, or where someone is storing extra fat tissue or no fat tissue at all, can be quite misleading. In this instance, just looking at a person you can’t objectively say how that person’s spine is actually aligned underneath that tissue, the only way you’re going to get to grips with the patient’s alignment is by doing a set of images.
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