In the sphere of spinal conditions and injuries, there is a missed diagnosis that health care providers around the world pay little attention to. Once explained, it is difficult to disagree with. The diagnosis is responsible for a plethora of spinal conditions that have been filling clinics and hospitals for decades. It is called Spinal Compression Syndrome, either acute or chronic.
Movement related injuries are typically caused by axial, rotational and flexion-extension compression forces. These forces are considered the "mechanism of injury", which of course they are. However, they are in fact a serious diagnosis as well.
As a typical thought, doctors agree that a patient can lift a heavy object, overload the tolerances of the spine, and create a disc, facet, ligament, nerve, tendon and/or muscle injury. The subsequent injuries created by the overload are always treated "as the condition". Many are resolved using a wide variety of "standard of care" modalities. But what has happened to the patient whose symptoms are seemingly resolved in their first round of therapy, yet over time, perhaps years, their symptoms begin to reappear? Why is it that in this case, certain activities or postures can begin to bring-on or aggravate what was seemingly a resolved condition?
Upon further investigation of this patient, often several years later, radiographic changes can be observed in and around the original injury site. Changes that were not observed on the initial x-rays. It indicates that this patient has a new degenerative diagnostic condition, such as degenerative disc disease, facet imbrication, hypertrophy, osteophytosis and/or focused ankylosing. Others might say that there were diagnostic components that were missed and ignored in the beginning of their initial care program, and in some cases its true. But I believe something else is happening. In my opinion, the only reasonable explanation is unresolved Chronic Spinal Compression Syndrome or SCS.
The etiology of SCS follows these basic thoughts and is greatly related to the intrinsic endurance of our anatomical tissues. In other words, the load bearing capabilities between people greatly varies from one spine to another. This in whole or in part is based on the inherited genetic tolerances of the individual. Some can tolerate great loads while others cannot. Why? Because our spinal anatomy has evolved and developed to tolerate and endure axial (vertical) strains and sprains singularly and repetitively. However, human tissues have limitations. For the person who is constantly lifting heavy objects and compressing their discs and facets on a day to day basis, self recovery (rebound) and repair in an ongoing process. But overloading or not giving the spine time to rebound, will result in degenerative and conditional changes.
I believe that the "rebound effect" of the spine is the major difference and factor between what one person's spine can tolerate over another. If you can agree with the theory of "rebound effect", then you would also agree that proper weight bearing exercises, core strengthening and nutrition can enhance a persons natural genetic rebound effect.
If we consider SCS as its own diagnosis, then the appropriate protocols for treatment need to be developed. They also need to become part of the "standard of care". The Robotic ATT is a stand-alone therapy for SCS as well as an essential modality to be used in combination with other non-surgical and surgical procedures. Removing SCS resolves many of the subjective complaints that your patients present with. It can also limit or stop many of the secondary degenerative conditions and sequel that often develop when chronic SCS remains.
You should not discharge a patient when there is evidence of remaining spinal compression syndrome.