X-Ray or MRI to Assess Posture?|Posture Doctor

An MRI machine is really just a gigantic magnetic that provides 3D images – it’s like been placed in the middle of a massive donut.

In this 3-part mini-series, we’re going to discuss X-Ray vs. MRI imaging. In Part 1 we’ll briefly talk about how each of these modalities works and whether or not they emit harmful radiation.

In Part 2 we’ll look at which one is the better choice for analyzing your posture, and finally in Part 3 we’ll look at some real examples of neck and low back X-Rays and MRIs and compare the two.

Part 1 – How do they work?

Lets start with MRI – Magnetic Resonance Imaging. An MRI machine is really just a gigantic magnetic that provides 3D images – it’s like been placed in the middle of a massive donut.

You don’t really need to know how it works, but I happen to think it’s fascinating. 

So humans are made of water and water is made of hydrogen and oxygen. Hydrogen has a positive charge because if you recall from highschool chemistry, it has one proton.

When the body is placed in a strong magnetic field, such as an MRI scanner, the protons in each hydrogen atom line up along the same axis. When the magnetic field is then turned off after say 20 minutes, the protons flip back again and this causes a signal; and this signal is used to create the image.

Because an MRI uses magnets, or magnetic radiation, it isn’t considered harmful to your body.

X-Rays work differently; they also use energy but not from a magnet. The beam of energy from an x-ray, comes into contact with your body, and is absorbed in different amounts by different tissues, depending on the tissue density.

An x-ray beam passes straight through softer tissues and looks black on film, but gets absorbed by denser materials like bone and these structures look white on film.

Xray imaging is ionizing radiation. In other words it delivers much more energy into the body than an MRI. This high frequency energy causes atoms or molecules to gain or lose electrons. This can damage a cell. Damaged cells divide and create more damaged cells. That’s why we don’t x-ray pregnant women; because there is a lot of cell division happening there.

Before we freak out about having an x-ray. Let’s put this into perspective. There are many items we use daily that emit low dose radiation. Sunlight, cell phones, tablets, computers, wifi routers, microwaves, cigarettes, television and fertilizers. It’s the cumulative effect of yearly radiation that’s important here.

In Canada, the Nuclear Safety Commission sets a limit of 50 mSv of maximum allowable radiation in a single year and 100 mSv over 5 years; or an average of 20 msv per year.

Perspective is what’s important here. The benefit from having a structural diagnosis of your neck (0.2 mSv) provided by x-ray far outweights the risk of radiation harm. In fact, one seven-hour flight will give you the equivalent radiation dose of two neck x-rays, according to the x-ray risk calculator.

The only reliable means for analysing the bony structure of your spine, is x-ray. Your healthcare practitioner can not, under any circumstance, diagnose your structural problems with only a physical examination; regardless how skilled there are!

It is therefore crucial to have an x-ray before the start of treatment and/or exercise programs begin. We will discuss this in much detail in Part 2 of this mini-series on X-Ray and MRI.

Further Resources: Forward Head Posture – Cause and Cure

Morning Stiffness | Do You Have Wear & Tear?

Sometimes called degenerative joint disease or “wear and tear”. Wear and tear is a euphemism for osteoarthritis (OA); the most common chronic condition of the joints. It occurs when the cartilage or cushion between joints breaks down; often leading to pain, stiffness and swelling.

In front of me you can see four models of the same two lumbar vertebrae, presented as textbook normal and phase 1, 2 and 3 of spinal degeneration. This is also known as osteoarthritis (osteo meaning bone), degenerative disc disease, or commonly wear and tear.

Normal vs. Phase 2

I don’t like euphemisms. I think you can handle the truth and that like me, you probably don’t like being talked down to. So let’s call it what it is … osteoarthrtis or degenerative discs or spinal arthritis. 

A normal lumbar segment has two vertebra and a healthy cartilage disc in between. If you look at the disc from the top, you can see that the gelatinous or gel-like toothpaste substance, is well contained within the cartilage rings of the disc.

There should also be good symmetrical bony alignment. You may choose to have a chiropractor detect whether or not you have any spinal misalignments. Early on, these subluxations are easily detected and corrected.

A normal spinal segment will also have healthy nerve roots. Lots of space for them to communicate with the body (your organs, bloodvessels and glands). Because our nervous system runs our body, we don’t want any interference from misaligned vertebra (poor posture) or degenerative discs.

Incorrect Posture May Cause Degeneration

Asymmetry in the body (incorrect posture) can lead to early degenerative changes. Posture is so much more than what we see on the outside of our body.

Phase 1

In Phase 1 of spinal degeneration, we may start to see wear in the discs. Evidenced only on MRI imaging, this is a kind of dehydration that occurs in the cartilage tissues..

The rings of cartilage that make up our spinal discs, start to break down. The gelatinous center begins to dry out, a little bit like the toothpaste that is stuck around the outside of the cap. There are likely no effects as yet (or mild effects) to your nerve system.

Phase 1

These people may not present with health problems at this early stage, or they may have some mild symptoms.

Phase 2

After a decade with incorrect posture from poor habits, childhood injuries, athleticism and manual labouring, it is more common to see people with Phase 2 degenerative changes.

Typically, discs are now very dehydrated. The gelatinous nucleus (the toothpaste-like substance) has often leaked right through the dried out cracks in the cartilage rings, that buldge into the space where the spinal cord lives. This is known as a slipped or herniated disc.

There is often nerve irritation in Phase 2. These people often present with leg pain (sciatica); as the nerves that exit the lower lumbar segments, travel through the buttocks and down the leg.

Phase 2 – Herniated or Buldging Discs

Further Resources: Sciatic Leg Pain Relief

They may also present with other health issues (bowel and bladder troubles), as these nerve roots supply our organs, blood vessels and glands in the pelvic region.

In Phase 2, the vertebral bones get closer together, and the ligaments and muscles become slack. There is now excess movement in the bony segments. They have become unstable, and the body responds by laying down more calcium to stabilise the segment. These calcium deposits or bone spurs aren’t generally painful, but lead to stiffness.

Morning stiffness is a strong indicator of spinal degeneration. After waking, it may take a few hours before a person with Phase 2 degeneration feels mobile. 

Phase 3

After a several decades with incorrect postural alignment, past accidents, poor lifestyle, we begin to see advanced arthritic (degenerative) changes. In Phase 3, the discs have completely dried up and can lead to total bony fusion between the vertebral segments of the spine.

Not only is this person extremely stiff, but their spinal segments no longer move independently. This person surprisingly, is often without pain but they are extremely stiff and immobile.

Phase 1, 2 and 3 can only be diagnosed by x-ray and/or MRI. X-Ray imaging show us bony changes and MRI show tissue changes. MRI is the imaging of choice for degenerative disc diagnosis, and x-ray imaging is gold standard for alignment and postural diagnosis.

If you have been diagnosed with wear and tear without an x-ray, you have been done a disservice, in my opinion. A good practitioner can probably accurately guess your diagnosis from signs, symptoms and examination, but they will never be able to accurately assess whether you are in Phase 1, 2 or 3. This is why I would never practice without on-site x-ray facilities.

My first Chiropractic Clinic Align

A person with Phase 3 may present with multiple health issues because the nerve roots are usually seriously comprised in this phase of degeneration. 

Obviously the right time to start paying attention to your posture is at the stage of postural misalignments – before the discs and nerve roots become compromised. While it is never too late to start creating a healthy posture habit for life, the longer we put off getted started, the more likely we are to enter Phase 1, making improvements more challenging and time consuming. 

If I can correct and improve my posture, given my bunion (argh), anatomical short leg, lumbar scoliosis and disc degeneration, anyone can. But please start today!

Forward Head Posture – When To Get X-Rays

The only reliable means for determining the cause of your forward head posture, is an x-ray. Your practitioner can not, under any circumstance guess the cause of forward head posture with only a physical examination.

Considering the head gains 10 pounds in weight for every inch of forward head posture, it is hardly surprising that your neck and shoulders ache considering you are carrying a watermelon around on top of your shoulders, now is it?

When the head moves forward (forward head posture) our center of gravity moves forward causing an increase in the muscle effort in the back of the neck and upper back. 

But is your forward head posture capable of making you sick? What are the health implications of this type of posture?

Rene Cailliet, an American born physician of French ancestry, was one of the pioneers in physical rehabilitation and is well known for his books on musculoskeletal medicine. 

You can realign your entire body by moving your head … your head held in a forward position can pull your entire body out of line.  Rene Cailliet

He goes on to explain that the vital lung capacity is reduced as much as 30% with forward head posture.

Forward head posture also causes compression in the upper neck joints (which causes pain and irritation). In order to prevent your forward head from falling toward your chest, your muscles sustain continual contraction, which causes nerve entrapment and artery compression. It isn’t hard to see that there exists the potential for neurological and vascular complications as a result of forward head posture.

What causes forward head?

There are many causes of forward head posture and they all require a different treatment approach for best results.

  • Shyness & lost confidence
  • Trauma (causing changes to your ideal neck curve)
  • Osteoarthritis
  • Degenerative disc disease
  • Hyper-kyphosis from Osteoporosis and other spinal conditions
  • Poor posture habits (long-term slouching)

When to x-ray?

By the time forward head posture becomes a confidence issue, it may already be significant. Forward head posture can be improved with a simple chin tuck but, and this is an extremely important but, the type of exercise that is appropriate, should be determined from the cause.

The only reliable means for determining the cause of your forward head posture, is an x-ray. Your practitioner can not, under any circumstance guess the cause of forward head posture with only a physical examination. Because the type of exercises and rehabilitation will differ, depending on the underlying cause of your forward head posture, it is essential to have an x-ray before treatment and/or rehab begins. This, unfortunately is not the typical approach I see in health-care today.

If you’ve already had treatment or exercises for your forward head posture and see no change in your appearance and still have pain, you may need a structural diagnosis and this you obtain through x-ray analysis.

If you think you have forward head posture, I’d love your comments on this – drop them in the comments box below.