December 2005

The source of symptoms examination

by Dr. Howard Loomis

This is the third column in a series inspired by a CEU seminar recently held at Logan College titled, "Options for Enhancing your Practice." The seminar presented useful ideas that can be easily incorporated into your practice. For my part, I decided to present a quick and easy examination that consistently determines the true source of a patient's symptoms rather than pinpoint the body's compensations for treatment. This exam simultaneously educates and inspires the patient while featuring a chiropractor's strong points; namely, observation, palpation and range of motion tests.

The heart of the exam can be done in less than five minutes and the entire procedure in less than ten. In the previous two columns, I suggested that it should be performed at a special time, in a special room, with a special assistant, for a special fee (not a normal office call). The exam can be used for new patients, but it is also an ideal way to re‑examine problem cases that are not responding to your satisfaction or to that of the patient's. The point is to find the originating and continuing cause of the patient's symptoms, because once the cause is known the treatment becomes obvious.

What do you have to see before you know what to do? How confident are you in your examination, and does it educate and inspire your patients? Perhaps the way to enhance your practice and reinvigorate yourself is to use a special examination and put a new but simple emphasis around it!

October's column featured a 30‑second postural analysis designed to locate obvious muscle contractions. Identifying muscle contractions is an incredible but underused diagnostic tool. A great way to use this is to place the patient in front of a full‑length mirror. You then stand behind the patient and place your hands under the patient's mastoid processes, on top of the shoulders, on top of the iliac crests, behind the knees and simultaneously on the tips of the internal malleoli. The patient will be able to see any distortions, and you will have their undivided attention.

Head tilt

If you find that the mastoid processes are not level, make note of this and bring it to the patient's attention. Then, with the patient still standing, palpate for muscle contractions that may be producing a head tilt and symptoms related to the head and neck. Palpate anterior and superior from the angle of the jaw at the prominence of the Masseter muscle when the jaw is shut. This area is specific for the Masseter and Temporalis muscles that close the jaw. It is the site of Chvostek's sign for tetany (indicating calcium and protein deficiency) and for temporomandibular joint (TMJ) syndrome. Interestingly, the temporomandibular joint and the intervertebral discs are very similar structures and require identical nutritional support. Muscle contractions found here may be related to those found in the Erector spinae muscles.

Don't be surprised if you find any of the following symptoms related to muscle contractions found at this stress point:

***  History of spinal disc problems or back surgery

*** Bone spurs in spine or heels

***  Irritated or receding gums, loose teeth

***  Clicking jaw or jaw pain

***  Slow reaction time, inability to concentrate

Next, palpate within the Temporal fascia, especially superior and anterior to the auricula. In addition to the large Temporalis muscle, the Auricular superior muscle is found here. Tenderness on the side of the head may begin at the mastoid process and move around the ear into the Temporal fossa. It may continue forward, below the temple, and above the orbit or down over the angle of the mandible and ramus of the jaw. Common symptoms associated with these muscle contractions are:

***  Earaches

***  Vertigo

***  Migraine headaches (hemicrania)

***  Blood pressure problems.

Invariably when a patient presents with a head tilt and tenderness in either the Masseter or Temporalis muscle, a structural misalignment of the upper cervical vertebrae is the cause. Most frequently the Atlas will be listed PS and/or the Axis listed as PI.

You can perform what I have outlined in this column in less than one minute, yet you will have accumulated valuable information, allowing you to rule out certain causes of the patient's symptoms. If you find painful muscle contractions, the patient will frequently ask why other doctors haven't found them. You will need to find an answer, but you have elevated their opinion of your diagnostic abilities and that is a great way to enhance your practice.

We'll continue our source of symptoms exam next month as we move lower in the cervical spine and onto the face.

(Dr. Loomis welcomes input on the subjects covered in this column. To make a comment or ask a question, write to him at 6421 Enterprise Lane, Madison, WI 53719. Visit www.loomisinstitute.com online or call 800‑662‑2630 for information on upcoming Loomis Institute seminars.)