October 2005

Solving problem cases brings success

by Dr. Howard Loomis

Successful doctors treat the cause of the problem, not the symptoms.  They are able to quickly and accurately determine the source of the patient's stress, devise a plan of treatment, and confidently convey their findings to the patient. They specialize in helping problem cases  ‑‑ the ones no one else can help. They solve these cases by identifying the specific causes of disorder, discomfort, or disease that have not been identified elsewhere.

What tests can you perform in your office that other practitioners do not? It surprises me to find that so few chiropractors perform a quick and easy postural analysis during each visit. A quick visual inspection only takes about 30 seconds, in fact, you don't even need a plumb‑line.

First recall that all stresses manifest as muscle contraction regardless if their source is structural or functional. That's right, any visceral dysfunction will produce involuntary contraction in the muscles that share the same spinal innervation as the involved organ. This is a good place to define muscle contractions versus muscle spasms. According to Dorland's Illustrated Medical Dictionary, muscle spasms have a sudden and violent onset and involve altered function. Involuntary muscle contractions are not sudden and certainly not violent, but they do involve reduced range of motion.

If you haven't thought about postural analysis lately, let's review posture and what it can tell you quickly and inexpensively. We will quickly scan for: head level, shoulder level, hip level, knee flexion, and ankle pronation. That should take about 30 seconds, but will yield a great deal of information.

Head tilt

This usually involves misalignment of the Occipito‑Atlantal condyles and cervical flexion‑extension problems. When palpation reveals painful muscles on the high side, the patient is usually experiencing stretch‑related symptoms such as muscle tension headaches. Painful muscle contractions of the low side are usually related to compression‑type symptoms such as vertigo and migraine headaches.

Low shoulder

The low shoulder is usually the side of dysfunction and symptoms. But  remember that non‑traumatic shoulder complaints can originate anywhere in the body. For example, when the low shoulder is on the same side as the low ilium, we might suspect a significant leg deficiency of more that 3/8". When the low shoulder is on the side opposite a low hip, we might expect a leg deficiency of less than 3/8".

However, many functional problems such as bowel irregularity or lymphatic and respiratory congestion are often involved. Another frequent source of shoulder symptoms is digestive inadequacy and the appearance of a Pottenger's Saucer. Loss of rib excursion on breathing will produce shoulder symptoms and painful stress points within the Infraspinatus fossa.

Lateral spinal curvatures

Convexity of the spine will appear on the side of the low ilium and leg deficiency. These are always quite obvious to casual observation. However, many such fixations are present that are not obvious until you have the patient bend laterally at the waist and observe the normal "C" shape appearance of the spine. This maneuver will expose many hidden causes of structural and functional problems.        

Low ilium

A low ilium can result from many causes, but invariably is on the side of high weight on a bilateral scale. Leg deficiency is probably the most common and can be caused by a dropped arch in the foot or a fracture in the lower extremity. Hip rotation may be severe enough to produce an unleveling of the pelvis.

Lateral pelvis

A lateral shifting of the pelvis is a frequent sign of sacro‑iliac involvement, but the key to resolving this problem is often seen at the level of the 5th cervical. The works of both Gravel and Reaver are convincing in this regard.

Flexed knee

Unfortunately, this phenomenon is frequently overlooked. The flexed knee is associated with cartilage damage and even condyle damage on the convex side of a scoliosis. A valgus deformity may appear on the side of greatest ankle pronation. Knee flexion will appear on the side opposite a leg deficiency and produces a shearing type wear‑and‑tear in the hip joint above it.

Ankle pronation

Ankle pronation results in a "toeing out" of the foot when walking. This is of critical importance when treating a lumbo‑sacral instability. It is interesting to note that studies have indicated that 40 percent of the population has a second metatarsal that is longer than the first. This is known as Morton's Syndrome and is responsible for many orthopedic problems. This causes the foot to roll off the second toe instead of the larger, and structurally stronger, big toe, resulting in lateral heel and medial sole wear.

Hemipelvis

Studies indicate that 20 to 30 percent of the population needs an ischial lift to level the pelvis when sitting. The implications in scoliosis are evident.

Conclusion

What do you have to see before you know what to do? Remember, the secret of your success is determined by how quickly and accurately you can determine the source of your patient's stress, devise a plan of treatment, and confidently convey your findings to the patient.

(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.)