Flexion Extension X-ray Analysis:
Using Forensic Evidence to Prove Serious Injury

Dear Attorney/Doctor,

Thank you for visiting our website. My name is Sangwoo Mah, DC, DAAMLP. I feel privileged to be the first one to inform you about an exciting new diagnostic test. The test is called Flexion Extension X-ray Analysis, or FEXA. It is used to diagnose a permanent condition called Alteration of Motion Segment Integrity, or AOMSI. The diagnosis of AOMSI via FEXA verifies the following statements according to the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition.

  • 25% Whole Person Impairment Rating – same rating as an amputation of a foot.

  • Same DRE Category as a severe spinal compression fracture with over 50% of vertebral body collapse.

  • Evidence of severe trauma and serious injury.

FEXA is performed by measuring position of vertebrae on standard flexion and extension x-ray images. Flexion and extension x-rays can be easily performed at any radiology facility. These images are uploaded onto the FEXA program and the movement of each vertebra is measured, and an impairment rating is calculated according to the AMA guidelines. The result is a simple yet powerful report that is easy to explain and understand.  

FEXA ImageDownload a FEXA sample report.

CLICK HERE for a FREE webinar on FEXA.

The diagnosis of AOMSI via x-ray analysis has been a standardized medical procedure since the early 90’s. But it has been performed infrequently due to impracticality of manually measuring images on x-rays films with rulers and protractors. Now, the invention of FEXA program has made diagnosis of AOMSI efficient and accurate.

A positive diagnosis of AOMSI via FEXA means there has been severe trauma that resulted in the ligaments connecting the vertebrae together to become permanently stretched or torn. This permanent stretching of ligament is called ligament laxity. When there is ligament laxity in the cervical or lumbar spine, it causes spinal instability. Spinal instability causes accelerated spinal degeneration. Spinal degeneration can mean severe pain, difficulty with activities of daily living, and even permanent neurological deficit .  This is why the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, rates the diagnosis of AOMSI at 25% Whole Person Impairment Rating, which is equivalent to a rating given to a severe spinal compression fracture.

AOMSI cannot be diagnosed with a routine physical examination, which necessitates FEXA testing for patients suspected of having ligament laxity. Since patients cannot control the individual movement of vertebrae on x-rays, FEXA test is completely objective on the part of the patient.

About 1/3 of all injured motor vehicle accident victimes will test positive for AOMSI with the FEXA testing. There is a high chance that AOMSI will be diagnosed by the FEXA testing, even with unremarkable MRI, ROM, EMG, and X-rays. FEXA testing can greatly help attorneys in proving that their clients have suffered serious injuries, despite minor vehicular damage and unremarkable findings on routine testing. The patients are also relieved to hear that their pain is not “all in their heads”, as many of them were previously told.

I would be happy to discuss the use of FEXA testing in your practice and go over a sample report with you. It will be a time well spent and the FEXA testing could become a very useful tool to you for your current and future cases.


Sangwoo Mah, DC, DAAMLP