Explaining CRMA Spinal Ligament Injury Testing to Your Patients

I want to talk about explaining CRMA results to your patients. CRMA is Computerized Radiographic Mensuration Analysis. It's a spinal ligament injury test that picks up the imaging biomarker of a ligament injury. An imaging biomarker is something that is detectable on an image that leads to a definitive diagnosis. There are 220 specialized ligaments in the human spine, 23 of which are discs. If we have a disc derangement or disc herniation, that's an imaging biomarker that is picked up on MRI. We can also have excessive motion, which is the most problematic ligament injury there is. That imaging biomarker is picked up on standard stress radiology. We know that there's normal ranges for the movement of an intervertebral body. We know that there are abnormal movement ranges and we know there are seriously abnormal movement ranges that are consistent with what is left behind with a ligament injury.

You first must explain to the patient why you are doing this testing procedure and what you are looking for in the results. After you have done this, you have positioned yourself as an expert in this area by saying, "Look, this testing is what we do in order to determine the severity and location of a ligament injury. This is the most significant injury that the spine can undergo. So we only use the highest level of professional and competent radiologists that we can find to perform this service." You are elevating yourself and your status. You've already done this with the patient. You've already explained why you're sending out for this procedure. You've already explained to the patient that this is unique.

I have also educated doctors to tell their patients in their consultation that the majority of people out there that have chronic pain today, have the condition that this test picks up and they've just never had it diagnosed. It goes undiagnosed so they are living with chronic pain when they could actually be getting help. Having this conversation with your patients will get you more referrals. It assists you with getting more non-injury referrals because remember, the thing that causes acute pain in an injury state is the same thing that causes chronic pain. It is the same condition.

Now you are at the visit where you need to explain their results. For example, Mark’s test came back and indicates a C4 on C5 nerve problem, or you have C4 on C5 alteration of motion segment integrity at that state for translation findings.

You are explaining, "Mark your test results came back. I've got them. It shows that you have severe ligament damage in the middle part of your neck." I would touch the patient, I would point to it. You don't have to give them the report, that's not important. Those are not the important things. "Mark, here's what is important. It came back, there was significant ligament damage. Now what that does is it doesn't change our treatment goals. The treatment goals that I said to you in the report of findings are still the treatment goals today. Those goals are to have you pain-free at the end of our care and have you have no chronic pain, no chronic situation at all with this condition. To have it not interfering with any activity of your daily living and do not have it interfere with your ability to earn a living at all. I want you where you feel like you never had the injury in the first place. That's the goal. Now, what this test tells me though, is that you're at much higher risk for a thing called long-term residual complaints. Those are conditions that never fully go away. That's a chronic condition. You're at high risk for that. Now, here's the thing that I need to tell you. You are the patient that cannot miss care. You can't miss visits. You can't miss anything that we're telling you to do in treatment. You have to be a stellar patient because I'm not just working on your spine to reduce down your acute pain and the situation today, as a provider, I'm looking at your spine and your spinal health 10, 20, 30, 40 years from now. Seriously, I'm looking at your future when we are doing this treatment program now."

"It's my job, as your guide, to get you through treatment and you'll understand it as we go. So here's what I'm telling you, as a result of this condition, you've got to be really good with treatment. You also have to be really good with communicating to me. If I have you do an in-office rehab procedure, I will have you do an at home exercise program, and any of this seems to bother you at all, I need you to tell me right away. Tell me right away. Okay? This is information that I need to know. Now, I gave you injury recommendations about water, about sleep, about an anti-inflammatory diet." (Doctors, we have a thing called SmartInjuryRecommendations that are just basic fundamentals that you're going to give the patient to get healthier in the first place and to reduce their own inflammation.)

"I've given you those recommendations. Those are good things to do, right? I need you to know that with this level of ligament damage, it causes an instability in the spine. Anything that's unstable is prone to erratic or unpredictable behavior. Your spine may be good for a while and then you can have a flare up. Now, that's going to be important for you to know because we're going to be talking with you about supportive care toward the end of your care."

Doctors, I am initiating supportive care conversations in week one because it's the truth. "What that means is that I'm going to be recommending probably, no matter how well you do in care, that we do two to four visits a year for the next two years after you're done with care just to support the care that we did and then I'll want you to take a look at doing..." My patients that see me twice a year or four times a year, and they do it for 30 years, are going to be much healthier than my patients that wait 10 years, don't see me, and now they come in with some sort of situation and now they want me to fix it.

So it's much easier to take care of a spine a little bit over time than it is to take care of a spine that has been badly neglected for years or decades. But this is a  talk we're going to have toward the end of care. I just want you to know that we are going to be having that conversation. Doctors, you're starting to talk about this now just by being in your report to the patient and you're allowing the patient to ask you now, any questions that you want to ask them. You're telling that patient, "Look, this is the other thing with this condition is, in treatment, a lot of times everything's going to go really well, so you'll spend a month or two and all of a sudden you realize, oh my gosh, I feel like I'm a hundred percent better and I should be done with treatment."

And then suddenly you watch a football game on a Monday night; You sleep wrong on your neck; It  feels like you're right back at day one. You are not back at day one. Now doctors, if you don't tell them that they can hit this, here's what's going to happen. They're going to think that your care is not working. So if you tell them that it could happen and it happens, your status goes up. So now you're basically telling the patient if that happens, you just come in for a visit or two and I'll have you right back to where you were. That's the nature of this condition. Now, if you tell them that and they hit it, they will be back in your office.

If you don't tell them that they may have flare ups, they might be in their office and complaining that their neck hurts.  Their coworker might say that chiropractic care didn't work for them and that they went to a physical therapist or other doctor. The next thing you know, your patient is now in that other doctor or physical therapist's office because you didn't tell him they could have a flare up. They will think your treatment didn’t work.

At the end of care when you're talking to them about supportive care.  That you routinely want to have patients see you either twice or four times a year for the next two years after an injury. Just for some routine supportive care. Remember, you're releasing a patient who is on consistent care with you. You don't know how it's going to be when they're not with consistent care.

If they opted not to take up that recommendation, then I just reminded them that their injury causes an instability. If two months, three months, six months, a year, two years from now, the pain that they feel now starts to it starts to come back, I don't for a minute, want you to think our care didn't work. It worked perfectly. And doctors, if you don't tell patients this and the pain does come back two, four, five, six months later, they think your care didn't work. You tell them, "No, it's not because the care didn't work. It's because it needs some supportive care. Come right in, right away, do an adjustment or two and let me get you right back to where you were." Doctors, that's what you want to talk about.

Now, the other thing that you want to talk about at that point is the fact that they have injury analysis, always. This is obviously not when you're talking to the patient about their report. This is more into when you're talking to the patient at the end of care that you always have a baseline of their injuries and that baseline can always be retested and that's the beauty of a CRMA test. But doctors, what you want to do in that report is, you want to explain the fact that you want to increase their compliance and you also want to explain, "Look, this is the number one situation that most people don't have diagnosed and when they get injured they need to have this diagnosis."

So you want to position yourself as that doctor for their friends, their family, their coworkers, the people that they know that have chronic pain, that are in injuries, that are getting bad care because they're working with doctors that don't even know how to determine the severity and location of the injuries that they have. This is what makes SmartInjuryDoctors smart. This is what makes SmartInjuryDoctors competent. So it's important to go over those things when you're going over that CRMA report.

For more information on Spinal Ligament Injuries please check us out at www.smartinjurydoctor.com or check out our SmartInjuryDoctors? Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board certified medical radiologists go to www.thespinalkinetics.com