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Jeffrey Cronk, DC JDJan 31, 2024 9:17:50 AM4 min read

Understanding Spinal Soft Tissue Complexities in Chiropractic


Spinal soft tissue injuries represent a significant portion of spinal injury cases found in chiropractic practices today.  This article delves into the importance of understanding spinal injuries, the role of chiropractic care, and how chiropractors can better navigate the medical-legal aspects of these cases.

Understanding Spinal Soft Tissue Injuries

Chiropractors generally understand that only two tissues make up the spine, the bones of the spine called vertebrae, and the tissue that holds it all together, called connective tissue (ligaments). The spine comprises 220 macro ligaments, 23 of which are discs, and the rest are non-disc spinal support ligaments. Injuries to these ligaments are easily evaluated with modern excessive motion testing for non-disc spinal support ligament damage and modern MRI for disc damage.  No spinal injury assessment is complete without both imaging studies, and injuries to these spinal ligaments is the most common cause of both acute and chronic spinal-related conditions as indicated and confirmed by such common sites as Medscape. Chiropractic has been successfully treating these conditions for over a century and their science is being studied and applied by other allied professionals to improve their treatment results in this area of injury practice.

The Importance of Guidelines and Documentation

All surgeons, medical specialists, family practitioners, osteopaths, physical therapists, and chiropractors operate under strict professional guidelines, which are essential for diagnostic procedures and rationales and for validating treatment approaches. For chiropractors, familiarizing themselves with these guidelines is not just about adhering to standards but also about understanding the depth and implications of spinal injuries. Proper documentation based on these guidelines can protect chiropractors from issues like insurance clawbacks and accusations of unnecessary care. When any doctor in the spinal injury space does not know or aheres to their guidelines, these problems can easily arise.

Objectivity in Diagnosis and Treatment

Objectivity is key in the diagnosis and treatment of spinal injuries. Verifiable factors, such as the presence of a herniated disc or excessive spinal motion due to a non-disc spinal support ligament injury causing clinical spinal instability, provide a concrete basis for treatment decisions. This objectivity helps chiropractors communicate the necessity and effectiveness of their treatments to other healthcare professionals, legal representatives, and insurance providers.

Chiropractic Care: Beyond the Surface

Chiropractic intervention is crucial for the management of spinal injuries. For example, in cases where there is excessive translation motion of 3.5 millimeters or more in the cervical spine due to injury of the non-disc spinal support ligaments, patients might be faced with the option of undergoing invasive procedures like spinal fusion surgery. However, chiropractic aims to manage and stabilize such severe conditions through non-surgical means, highlighting the significance and effectiveness of conservative treatment modalities.

Chiropractic guidelines require their practitioners to accurately assess the extent and location of any non-disc spinal ligament injuries via radiographic analysis, as stipulated in these guidelines.

It is widely recognized among seasoned chiropractors that an incomplete understanding of a patient's injuries—both in terms of severity and specific location—can lead to suboptimal treatment outcomes. Conversely, chiropractors who diligently adhere to these scientific principles in their practice are likely to achieve superior long-term results with their patients, and may succeed in managing or even salvaging cases that have not responded well to interventions by less specialized providers, including other chiropractors.

Navigating the Medical-Legal Environment

Chiropractors frequently encounter obstacles within the medico-legal landscape, especially in the domain of spinal injury treatment. A common perception is that their expertise lacks credibility compared to that of medical doctors. However, a straightforward strategy to overcome these doubts lies in the thorough understanding and application of chiropractic guidelines, as well as the ability to coherently relate these to other established guidelines, such as the AMA Guides to the Evaluation of Permanent Impairment or guidelines for spinal fusion surgery accepted by insurers, among others. Mastery of this knowledge not only underpins effective patient management but also fortifies the stature of chiropractors as integral healthcare providers.

The Role of Chiropractors in Spinal Injury Recovery

Chiropractors are dedicated to achieving full recovery for their patients whenever feasible. They possess a profound understanding that, although an injury may be irreversible, the symptoms or adverse effects it produces need not be enduring. The most effective practitioners recognize that enhancing patient outcomes requires a deep appreciation of the complexities surrounding spinal injuries and adherence to the established treatment guidelines. It also involves welcoming the guidance offered by these standards and acknowledging their vital contribution to the rehabilitation journey of individuals with spinal injuries.


Spinal soft tissue injuries pose a significant challenge, being among the most incapacitating and costly conditions currently encountered in healthcare today. A portion of the chiropractic community has achieved considerable success in treating and rehabilitating these injuries. Their scientific approach warrants broader recognition and adoption, with the aim of enhancing patient outcomes even further.