October 2005

A child's first check‑up ‑‑ The examination:

Part 2 by Dr. Ogi Ressel

In Part 1, I talked about having this cute seven year‑old standing in front of you, with her back to you, and her mom looking over your shoulder at her daughter. Here's where you guide mom so that she can see what you see.

It's important to be able to place yourself in the shoes of the mother. Speak in a language that's clear and grounded in reality. Leave the technobabble for a later date. You want to make certain that parents track with you. After all, they make all the health care decisions (especially moms)! So...the learning gradient cannot be steep otherwise patients tend to fall off.

Also, make certain you're speaking to your little patient with dignity an on a par ‑‑ even if she's only seven. I've found that kids really appreciate being handled and spoken to as adults ‑‑ with respect, dignity, and love.

Make sure mom can notice what you're finding with her daughter and is in agreement ‑‑ it has to be her reality. I can almost hear Dr. Christopher Kent say, "What a concept." If she can't see what you see, then stop and make certain she has an opportunity to catch up with you. This can be tricky at times as many patients will not want to appear "stupid" and so may agree with you when asked whether they see what you're pointing out. They may nod their head, etc. indicating that they understand when, in fact, they don't have a clue.

In the meantime, you tend to babble on and then wonder why these patients have decided not to start care with you. This is a common mistake. Oftentimes, doctors get so excited explaining the chiropractic approach to their patients that they don't even realize a patient may not be tracking. It's easy to get caught up in hearing yourself speak. And then doctors wonder why they aren't getting referrals and patients are not starting care. 

The main thing here is to have mom in agreement so that what you are speaking of is real to her and her daughter. If there is no reality and no agreement, these patients are not starting care. Period.

Let's go back to your exam of this cute seven year‑old munchkin in front of you.

Here's where it gets really interesting.

You're kneeling down with your little patient in front of you and mom sitting on a stool, looking over your shoulder.

Place your hands on the girl's pelvis so that your thumbs are on each PSIS.

Ask your little patient to hang onto a doorknob, your wrists, a table, etc., for support and then ask her to raise her right leg, flexing her knee.

Notice and compare the movement of the right PSIS (your right thumb) to the left as her knee is raised ‑‑ it should descend. Repeat the same procedure on the left ‑‑ your left thumb should also descend ‑‑ this is normal.

But wait a moment. As this cute seven year‑old raised her left leg, your left thumb, which you fully expected to descend just like the right, actually ascended ‑‑ it went up.

Explain to mom that the pelvis functions much like a gyroscope ‑‑ there are opposing and counterbalanced forces at work, and that each side of the pelvis should function 50/50. This is normal.

Show her a repeat performance of what you just did and explain what you're finding. That the right side of her daughter's pelvis is functioning overtime (hypermobile) while the left side is not functioning at all (hypomobile). There is unbalance and inequality. She will totally understand.

Explain that this is most likely the reason why her daughter is beginning to develop the spinal curvature you found, her poor posture, and the symptoms she's experiencing.

If you noticed all that, I want to congratulate you. You've just discovered the Pelvic Distortion Subluxation Complex. This entity affects almost 100% of all children and its effects are widespread. This is a huge problem!

What you'll find is that 96% of all children will have a fixation subluxation of the left pelvis and a corresponding hypermobility of the right. The remaining four percent will have a fixation of both sides, or a fixation of the right ‑‑ but these are rare. I'll discuss what this means, its implications, and effects a little down the road.

I would really urge you to read my paper on this entity, published in October/04 in the Journal of Vertebral Subluxation Research (JVSR). It will explain things to you in great detail. Go to www.jvsr.com and have a good read. And while I'm on this topic, you should all become subscribing members of the JVSR. It's our Journal so let's support it!

Okay. You've just pointed out to mom that her child is not perfect. Tread easy from now on. You're creating a new awareness and credibility.

Your little patient may feel a bit of anxiety at this point, most of it the result of reading her mom. This is common. Relax. Explain that you'll give those answers as your examination unfolds.

Have your young patient sit on your exam bench and have a good look at her head and her face. Check out the level of her eyes, eyebrows, cheek bones, ear levels, and forehead, etc. As well, look for asymmetry in her face in general ‑‑ nose symmetry, lips, and chin. Also have a look at this patient's head symmetry from above, looking down.

Check the function of both TMJ joints and compare one side to the other. Have the little girl open and close her mouth and look for symmetry of function. Palpate both and determine if one side or the other is either hypo or hypermobile ‑‑ the hypermobile side will be tender to touch.

Measure each of her head hemispheres with a tape measure, starting from the External Occipital Protuberance to the nasium. Both measurements should be equal. To your surprise, you'll find that in a vast majority of children this is not the case. You'll find a difference of 1‑2 cm (you'll also be amazed to find that when this young patient starts being adjusted, the hemisphere measurements will tend to become symmetrical within one‑to‑three months). Ahhh...the power of Innate!

All these findings are important, as asymmetry in any of them points to TBS (Traumatic Birth Syndrome). Be able to show mom what you're finding and explain briefly your suspicions. Relate these to the APGAR score mom has given you in consultation. It's important that you make total sense to mom, and that all you are saying is logical to her.

Let me assure you that you have mom's complete attention at this point.

I'll continue my examination of your cute seven year‑old in Part 3.

Talk with you soon.

(Dr. Ogi Ressel, author, researcher and an x‑ray and pediatric specialist, teaches The Practice Evolution Program, the "fastest‑growing coaching program on the planet." Visit online at www.practiceevolution.com and take the Practice Health Mini‑Checkup. Dr. Ressel may be contacted by e‑mail at drogi@practiceevolution.com or by calling 800‑353‑3082.)