Chiropractic Dosing: Insight from MRI

Written by: James Demetrious, DC, DABCO

Diplomate, American Board of Chiropractic Orthopedists
Diplomate, International Academy of Neuromusculoskeletal Medicine

How Often Should We See Our Chiropractic Patients?

What metric provides insight into the appropriate frequency and duration of chiropractic care for acute facet synovitis?

A New Means to Determine Chiropractic Care Frequency and Duration

In their 2008 article published in the journal Pain Medicine, Mayo Clinic neuroradiologists Czervionke and Fenton described a means to improve the conspicuity of facet synovitis on MRI. [1] The authors reported:

“Facet synovitis is a common condition and appears to correlate with the patient’s pain. Detection of active inflammatory facet osteoarthropathy (facet synovitis) within and surrounding the facet joints is possible with MR imaging using a fat-saturation technique.”

The authors offered a means to image facet synovitis utilizing fat-saturated sequences:

They also offered a grading system for facet synovitis:

What Does this Mean?

By visually quantifying periarticular edema, one may draw conclusions that may provide insight into understanding chiropractic dosing. Chiropractic spinal manipulation may alleviate periarticular edema via venous and lymphatic drainage through improved segmental mobility.


It is reasonable to assume that a patient presenting with Grade 1 periarticular edema may require less care than a patient presenting with Grade 4 periarticular edema.

One may conclude that chiropractic dosing could be contingent upon the severity of periarticular edema.


  1. Czervionke and Fenton. American Academy of Pain Medicine. 2008; 9(4):400–406.


The views and opinions expressed in this presentation are solely those of the author. The information is not offered as a standard of care as research and care evolve. We offer this only to educate and inform. Patients should seek the care of their doctors regarding their conditions.

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