Healthcare is a team effort, and chiropractors bring important knowledge about the spine and musculoskeletal system to the table that can help patients with a variety of conditions. At Engage 2027, Eric Lee, DC, FSBT, will explore how an understanding of ligament pathology in particular can further open doors to collaboration with other providers and help them better understand the value of chiropractic care in advancing their patients’ health and mobility.
In addition to being a chiropractic physician and spine management provider at Summit Brain, Spine & Orthopedics in Lehi, Utah, Dr. Lee is a Fellow in Spinal Biomechanics and Trauma and adjunct faculty for the Master of Science in Interprofessional Spine Management program at Parker University. His Engage presentation is “Hidden Instability, Ligament Pathology in Spine Management.”
Read on to learn more about Dr. Lee and his presentation and make plans to register and attend Engage 2027.
How is the topic you are presenting at Engage 2027 relevant to today’s chiropractor?
EL: Chiropractors have valuable expertise to contribute to the healthcare system. The ability to diagnose a mechanical spine problem, explain its clinical significance, and work with other providers to manage it can make a chiropractor an important resource within their community. Many providers refer patients to me specifically because they want help understanding the mechanical component of a patient’s condition and developing a plan we can carry out together.
Understanding ligament pathology helps open those doors. The facet capsular ligaments contribute to spinal stability and contain sensory innervation involved in pain and position sense. Understanding these structures adds depth to how we evaluate spinal function and interpret a patient’s presentation.
This knowledge can influence how we approach a patient injured in a motor vehicle collision, someone with recurring neck or back pain, an older adult with degenerative changes, or a patient with persistent symptoms after spine surgery. It helps us ask more focused questions during the examination, look at imaging with greater purpose, and determine how the findings should influence treatment.
In personal injury and other medicolegal cases, it also helps us explain the suspected injury and develop a clinically supported opinion about causation. That requires considering the injury mechanism, prior health and function, symptom onset, examination, imaging, and other possible explanations together.
I want attendees to recognize that this depth of knowledge can strengthen both patient care and their role as a doctor other healthcare providers turn to for help.
Several research articles illustrate the relevance of this topic:
- Ligament integrity and spinal mechanics: Bermel EA, Barocas VH, and Ellingson AM. “The Role of the Facet Capsular Ligament in Providing Spinal Stability.” Computer Methods in Biomechanics and Biomedical Engineering, 2018. This computer-modeling study examined how simulated loss of facet capsular ligament function affected the L4–L5 segment. It found changes in spinal mechanics, including increased motion and reduced stiffness in certain loading directions. The findings provide a biomechanical foundation for understanding why ligament integrity matters when evaluating mechanical spine problems.
- Facet joint pain following whiplash: Lord SM and colleagues. “Chronic Cervical Zygapophysial Joint Pain After Whiplash: A Placebo-Controlled Prevalence Study.” Spine, 1996. In the group studied, diagnostic blocks identified cervical facet joint pain in approximately 60% of patients with chronic neck pain after whiplash. This foundational study supports considering the facet joints as a potential pain source in persistent post-collision symptoms and illustrates the value of a specific diagnostic evaluation.
- How imaging comparisons can change the assessment of motion: Nathan J. Lee and colleagues. “Flexion-Extension Standing Radiographs Underestimate Instability in Patients with Single-Level Lumbar Spondylolisthesis: Comparing Flexion-Supine Imaging May Be More Appropriate.” Journal of Spine Surgery, 2021. In 39 patients with symptomatic lumbar spondylolisthesis, comparing standing or flexion radiographs with supine MRI revealed greater changes in vertebral translation than the standard flexion-extension comparison. This illustrates why understanding the strengths and limitations of imaging—and how different studies relate to one another—can influence the assessment of spinal mechanics.
- Chiropractic care for patients with previous spine surgery: Trager RJ, Makineni PS, and Williamson TJ. “Patients With a History of Spine Surgery Receiving Chiropractic Spinal Manipulation in US Academic Health Centers: A Cross-Sectional Cohort Study.” Cureus, 2023. Among 81,291 patients receiving chiropractic spinal manipulation in the database studied, 10.8% had undergone spine surgery. This study describes patient characteristics and care patterns. To me, it reinforces the relevance of postsurgical patients to chiropractic practice and the importance of understanding surgical history, biomechanics, and opportunities for collaboration when managing these cases.
What makes you an expert in this area?
EL: I bring more than 25 years of chiropractic practice and a two-year Fellowship in Spinal Biomechanics and Trauma. My training included multidisciplinary rotations involving neurosurgery, orthopedic spine, pain management, neuroradiology, and physical therapy. That experience helped me connect anatomy and biomechanics with the decisions made throughout a patient’s course of care.
I work at Summit Brain, Spine & Orthopedics in a hospital setting, where my clinical work includes daily collaboration with neurosurgeons, orthopedic surgeons, pain management specialists, and physical therapists. This includes a close working relationship with neurosurgeon John Edwards, MD.
I also receive referrals from cardiologists, family medicine physicians, and interventional radiologists. These relationships reflect the value of having a provider who can evaluate a possible mechanical spine problem, explain the findings, and work with the referring clinician on appropriate management.
Working in this environment continually sharpens my clinical reasoning. I need to understand what information matters to the surgeon, what questions an interventional specialist may help answer, how rehabilitation fits into the plan, and where chiropractic care can contribute.
I also serve as adjunct faculty in Parker University’s Master of Science in Interprofessional Spine Management program and develop clinical education to help chiropractors apply these principles in their own practices.
What first interested you in this topic, condition, or area of practice?
EL: The question that has driven my interest is why some patients improve temporarily but remain unable to sustain that improvement in everyday life. They may feel better after treatment yet continue to struggle with sitting, working, exercising, or returning to the activities they enjoy.
I wanted a deeper understanding of the tissues involved and the mechanical factors that might be limiting recovery. That drew me further into ligament pathology, facet capsule function, and the relationship between tissue integrity and spinal movement.
As my knowledge developed, it also expanded the conversations I could have with other providers. I could offer a more detailed explanation of the mechanical problem and help connect that assessment to a treatment or rehabilitation plan.
That continues to motivate me. A deeper understanding of the problem creates opportunities to make better decisions, collaborate more effectively, and give patients a clearer understanding of their care.
Can you provide one or two takeaways from your presentation/topic that Engage 2027 attendees will not want to miss—and why?
First: Understanding ligament pathology can change how you interpret imaging and choose care.
I want attendees to look at imaging with specific clinical questions in mind: What structures may be involved? How do the findings relate to the patient’s symptoms and function? Is there evidence that should change the treatment plan or prompt further evaluation?
We will connect ligament and facet anatomy with the history, examination, and appropriate imaging assessment. We will also discuss what the findings can support and where additional information is needed.
This knowledge can influence treatment selection, technique modification, rehabilitation, and the decision to involve another specialist. It can enhance the approaches chiropractors already use by helping them determine what to treat, what to protect, and how to evaluate progress.
Second: Your ability to explain and manage a mechanical problem is valuable to the entire healthcare team.
I want chiropractors to leave recognizing the contribution they can make when they provide a clear assessment and a thoughtful plan. That applies to everyday spine complaints, personal injury cases, and patients who have undergone surgery.
For postsurgical patients, we will discuss how the procedure performed, healing status, neurologic findings, and function of the surrounding segments inform evaluation and coordination with the surgical team. For personal injury cases, we will discuss how to explain the relationship among the reported event, clinical findings, functional changes, and the reasoning behind an opinion about causation.
Being able to communicate that information clearly helps patients understand their condition and helps other providers understand how to work with you. Those capabilities help build the trust that makes a chiropractor a valued community resource.
How many times have you attended or presented at ACA Engage in the past, and what is your favorite memory?
EL: This will be my first time attending Engage, although I have previously presented at SACA.
What I enjoy most about presenting is helping doctors and students connect the material to a patient or clinical situation they recognize. There is a rewarding moment when a deeper understanding of anatomy or biomechanics gives someone a clearer idea of what to evaluate and how to proceed.
I also enjoy helping chiropractors recognize the value of their knowledge within the broader healthcare system. My goal is for attendees to leave with practical ideas they can apply, greater confidence in their clinical reasoning, and a stronger understanding of how they can contribute alongside other providers.
What do you enjoy about being a chiropractor?
EL: I enjoy helping patients understand what is happening and working with them toward meaningful improvements in their lives. Returning to work, exercising again, sleeping more comfortably, or being able to care for a child can be deeply important milestones.
I also enjoy the relationships that develop through collaborative care. When another physician asks for my assessment of a mechanical problem, I have an opportunity to contribute a perspective that helps the team move the patient’s care forward. That is a rewarding part of being a chiropractor.
What keeps me excited is the opportunity for our profession to continue earning trust through careful evaluation, sound clinical reasoning, and clear communication. Chiropractors can become highly valued resources for patients and colleagues who need help understanding and managing spine problems.
Helping patients—and helping other chiropractors recognize and develop that potential—is what keeps me engaged.
Register and attend Engage 2027.
