June 2006

The triangle test

by Dr. Howard Loomis

I have always believed that one of the purposes of our profession should be to educate the public on how to maintain their health and prevent disease. In other words, chiropractic should specialize in health care as opposed to sick care, which is practiced by Western medicine. One of our main focuses should be differentiating somato‑visceral causes of symptoms from viscero‑somatic causes. Our chiropractic education certainly equips us to do so very well ‑‑ in fact, better than anyone else in the healing arts. Yet, few chiropractors seem to recognize this specialty is available to them.

Consider that the vast majority of symptomatic patients do not have positive medical test results. A specific course of drug therapy cannot be established without identifying the true cause of such symptoms as: stiff, sore joints; constipation or diarrhea; headaches; restlessness or irritability; heartburn; anxiety; indigestion; depression; gas and bloating; and insomnia. Yet, drugs are prescribed for these symptoms despite their known side effects.

The underlying cause of these symptoms may be structural, but there may be a visceral cause exhausting the body's ability to maintain normal structure and function. This is a most important diagnostic question and every clinician should seek to answer it before initiating therapy.

You can quickly find the answer by palpating for viscero‑somatic stress points before and after correcting any spinal involvement. This diagnostic procedure is scientifically sound, legally defensible, and will lead to greater patient confidence in the practitioner's abilities.

Last October, I began this series of columns describing a screening procedure that should require less than five minutes. This exam would quickly uncover the source of a patient's symptoms. The introductory columns were titled, "Solving problem cases brings success," "Enhancing an existing practice," and "The source of symptoms examination." Subsequent columns described palpating for stress points involving the upper cervical spine, the eyes and sinuses, the face and neck, the shoulder, and the upper extremity.

(These and other columns can be accessed by year and month or by using the search feature at: http://www.worldchiropracticalliance.org/tcj/archives.htm)

This month's column describes a 30‑second orthopedic screening done in the long‑sitting position with the legs and feet outstretched on the table; hence, the name "Triangle Test." In this position, it is quite easy to check Bechterew's Straight Leg Test, Braggard's Test for Sciatica, Lindner's Sign, and spinal percussion. We will also examine for loss of the normal thoracic kyphosis in this position. These tests will help recognize orthopedic conditions including ruptured disk, fractured vertebrae, and neoplasms that would warrant additional diagnostic work‑up.

***  Bechterew's Straight Leg Test ‑‑ Have the patient straighten their legs while sitting. If there is pain in the spine (not muscle tension in the legs), the test is positive for possible disk involvement.

***  Braggard's Test for Sciatica ‑‑ After the patient has straightened their legs, passively dorsiflex the ankles by pushing up on the balls of the feet. This test is positive if it produces pain in the spine.

***  Lindner's Sign ‑ Meningeal Stretch ‑‑ With the legs straight and the feet dorsiflexed, have the patient bend forward at the waist and drop their head toward their chest. The test is positive if pain occurs in the spine (not muscle tension) upon dropping the head.

***  Percussion ‑‑ With the patient in Lindner's position and using two fingers, tap (percuss) on the spinous processes starting in the neck and working your way to the bottom of the lumbar spine.

If the patient experiences soreness with percussion, this indicates a strain or stress, such as arthritis or a subluxation.

If the patient experiences sharp, stabbing, or knife‑like pain, it may be indicative of a fractured vertebra.

If the patient experiences pain that persists for several minutes after percussion, this is indicative of a possible neoplasm (tumor).

Any of the above findings require immediate diagnostic confirmation. The key to understanding this test is not if percussion causes pain, but how long the SHARP PAIN lasts.

***  Pottenger's Saucer ‑‑ Next, keep the patient bent forward at the waist with their head flexed. Slide your fingers down the spinous processes from T1 toward T12. You should feel the "C‑shaped" posterior curve of a normal thoracic kyphosis.

Observe if there is a loss of the normal kyphosis and feel for a depression formed in the middle dorsal spine. This is referred to as a saucer because if the patient were prone it would hold water. This structural abnormality is associated with viscero‑somatic reflexes from the digestive organs (right anterior costal, epigastric, left anterior costal, and midgastric). It is not a permanent or static condition. It is transitory and is found not only with digestive dysfunction, but also with low blood sugar levels. It is almost consistently found in muscle contractions producing headaches.

Next time, we'll lay the patient supine and begin examining the abdomen for the source of Pottenger's Saucer.

(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 http://www.loomisenzymes.com online or call 800‑662‑2630 for information on upcoming Loomis Institute seminars.)