Six months ago, I started a series of columns drawing attention to the connections between spinal subluxation and peripheral muscle contraction. The first column was entitled "Subluxation: cause or effect?" I wrote about correlating somato-visceral findings with viscero-somatic findings. Which is the cause and which is the effect? Obviously, it differs with each individual case. But that is exactly how we should customize our treatment plans: based on the needs of the individual, not on total population generalities.

Following the original column, I wrote about recognizing symptoms that clearly suggest dietary modification is needed to assist a patient in restoring health and eliminating troublesome and recurring symptoms.

First, general digestive symptoms that cannot be easily categorized as to such as heartburn, gas pain and bloating. Can the source of the problem be found in the stomach, biliary system, or pancreas?

In the columns that followed, I wrote about symptoms that could be specifically related to protein, carbohydrate, and lipids.

This month, I wish to present the outline of a simple physical screening procedure that can be performed quickly during any office visit, and that will be both revenue- and referral-productive.

At any time during routine office calls but especially on completing your spinal therapy, have patients "long-sitting" on your examination or adjusting table – with their legs on the table and knees straightened. Ask them to bend forward slightly at the waist and slide your fingers down the thoracic spine, starting at T1 and going to the lower thoracic area. You normally will find a smooth uninterrupted kyphotic curve. If this is present, the findings are negative and the test is finished.

But if you notice a Pottenger's saucer, the test is positive.

A Pottenger's saucer is best described as a small and localized loss of normal kyphotic thoracic curvature. It usually involves three spinous processes that appear to have moved anterior. The vertebrae have not misaligned in an anterior direction, but rather muscle contraction is responsible for the apparent anomaly. The condition can be readily removed by a number of methods. Needless to say, spinal adjusting is a very effective method.

What is of immediate concern is not the correction but the cause. Invariably you will find the culprit is a digestive problem. After all, the stomach, biliary system, and pancreas are all innervated from T4 to T9. Ultimately, the spleen, liver and adrenal glands will also be challenged by any digestive disorder.

Vague and generalized digestive problems can easily be associated with this finding, but it is low blood sugar levels – both functional and reactive hypoglycemia – that will eventually result. The symptoms related to low blood sugar levels are many and are well-known, so I will not enumerate them here. However, two frequently overlooked clinical manifestations of low blood sugar levels are of major importance to our profession:

1. Upper cervical muscle contractions and related spinal fixations. I seldom have a patient complain of muscle-tension headaches that do not have associated Pottenger's saucer and digestive problems.

2. Pelvic muscle contractions associated with sacro-iliac fixations-a major and recurring complaint in chiropractic offices for over 100 years.

A deficiency of intake or digestion of either carbohydrate or protein will result in low blood sugar levels and produce a Pottenger's saucer. While all carbohydrate is digested to glucose, 57% of our protein intake is normally converted directly to glucose by the liver. Remember also that Pottenger's saucer is transitory unless it is a chronic and recurring situation.

Once you have found a Pottenger's saucer, determine whether it is resulting from a carbohydrate, protein, or lipid problem. Have patients lie supine on the table and relax. Ask them when and what they last ate. Next, gently palpate under the right and left anterior costal arches as well as in the epigastric area immediately below the xiphoid process of the sternum.

Look for muscle contraction in all three areas. These areas will be firmer than the surrounding tissue. They will also be quite painful if acute but will require prodding to elicit tenderness if it is chronic.

Muscle contraction under the right costal arch indicates poor protein and/or fat digestion; under the left, poor carbohydrate digestion. A compromised mucosal lining in the stomach and/or duodenum is indicated by muscle contraction in the epigastric area.

The presence of a Pottenger's saucer when none of these areas are positive indicates the patient is no longer struggling to digest food but has a low blood sugar level.

This simple yet reliable examination can be very helpful to you, not only for increasing income and referrals but in correcting recurring and stubborn subluxation patterns.