December 2007

What is the 2nd factor?

by Dr. Howard Loomis

The 2nd factor in Chiropractic was named for that portion of their income that many DCs let get up off the table and walk out the door never knowing it was there.

Let me say the same thing in a kinder and gentler way.

Structure is obviously the first factor in our profession and function (visceral) should be equally recognized as the second factor. Structure and function are inseparable. Dysfunction in one causes dysfunction in the other and that is (was) the essence of Chiropractic as expressed by DD Palmer and all of the other pioneers of this profession who followed him. Unfortunately, many would disavow the 2nd factor (function) and hand over the first factor to those physical therapists trained to manipulate.

Manipulation never was the center piece of chiropractic. The Chinese have written records and drawings of manipulations dating back 5,000 years. The ancient Egyptians used manipulation. Europeans frequented 'bone‑setters' and brought that to America. Chiropractic is the only health care profession that brought together the triad of anatomy, physiology, and neurology into one complete package. All other professions separate them. Consider the chart and realize that all symptoms can be summarized as musculoskeletal pain, visceral dysfunction, or neurological (dermatomal) in nature.

Amazingly, the medical community does not use this methodology when confronting symptoms that cannot be classified as disease. Nevertheless, drugs are used to mask the symptoms and hide the underlying cause with inevitable side effects. A medical doctor once told me, regarding that methodology, "if the only tool you have is a hammer then everything looks like a nail." Don't fall into that trap.

In January of this year, I started a series of columns designed to give even the busiest, high‑volume chiropractors a way to include the 2nd factor (visceral dysfunction) in their routine. The purpose was to help more patients and make the most cynical critics believe in the power of chiropractic.

I began by asking the question, what do you have to see before you know what to do? Aren't there some patients that continually have low back pain but no specific cause or injury to their low back? What about those patients who have shoulder pain or pain between their shoulder blades and, once adjusted, are back within days saying that they were good for only a few hours but the pain came back? Do you question why these structural problems continue to return, even though you have done a great job adjusting the area? It's a terrible thing to hear patients say "adjustments help but once you start with a chiropractor, you have to keep going."

This column is devoted to detection of visceral problems with few or no symptoms that perpetuate structural complaints. I want to help you expose visceral stress quickly and reveal it as a cause of chronic structural complaints. Once the cause is known the treatment becomes obvious ‑‑ and nothing succeeds like success.

The key to understanding how to assess visceral dysfunctions as they relate to structural dysfunctions is as follows:

***  1st factor ‑‑ muscle contractions and loss of range of motion are always involved in any structural problem.

***  2nd factor ‑‑ correlate possible visceral involvements through shared neurological innervations. Visceral dysfunction will also always produce muscle contractions.

***  Adjust the structural subluxation(s) and release the associated muscle contraction.

***  Re‑palpate the muscle contractions from visceral origins. If these are now relieved the problem was structural. If the visceral‑related muscles are still contracted and pressure‑sensitive the origin of the structural misalignment is visceral.

The examination procedure itself begins with a standing postural analysis which includes checking for head tilt, low shoulder, high iliac crest, knee flexion, and ankle pronation.

Next, check the seated patient for passive shoulder abduction and evidence of Pottenger's saucer (loss of normal thoracic kyphosis).

Place the patient in the supine position and check for evidence of foot flare and determine the side of structural weakness. Then, employ the cervical compression and traction tests. Finally, in the supine position, look for restricted passive internal and/or external leg rotation.

Now turn the patient prone and use your standard analytical and therapeutic indicators. After the adjustment, turn the patient supine and recheck any range of motion tests that were positive before your adjustment. If they are improved, then palpate whatever visceral involvements correspond with your spinal findings.

Whatever is positive will perpetuate a patient's structural problems and prevent complete healing. Structure and function are inseparable and successful chiropractors need to recognize dysfunction in one causes dysfunction in the other.

(Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison, WI 53719 or by phone at 1‑800‑662‑2630. Visit his website at http://www.loomisenzymes.com for more information about the 2nd factor in Chiropractic.)