February 2007

Diagnostic assessments made easy

by Dr. Howard Loomis

I believe it is self‑evident that you cannot separate structure from function. Anatomy strongly influences physiology and vice versa. They are linked unquestionably by neurology. This describes chiropractic as I know it, and I would submit an appreciation of this paradigm holds the key to unlocking many of the diagnostic conundrums we all face daily in our practice.

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.

As chiropractors, we often address the structural problem only ‑‑ the first factor ‑‑ treating the patient over and over again for the same complaint. I respectfully submit that there is a second factor in chiropractic that can make a very big difference in how you approach your practice, your patients, and your profession.

Many patients continually have some structural complaint that requires periodic treatment, yet permanent alleviation is never achieved. Often, no specific structural cause can be found, yet there is a chronic recurrence of the same subluxation pattern.

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 this quick and easy assessment system 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 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.

Stress point system rationale

The brain is connected to receptors located in the skin, muscles, and organs of the body. These connections develop together in the embryo (ectoderm, mesoderm, and endoderm) during the third week of embryonic life and remain connected to the brain via the spinal cord. Sensory signals from these receptors pass along spinal nerves to the cord and ascend to the brain. The brain then relays motor signals back to the tissues via the reticulospinal tract (autonomic nervous system). Of particular importance here is that all three tissues are stimulated to respond simultaneously.

This was first proven in 1898 by English neurologist Sir Henry Head, who found that any visceral dysfunction was accompanied by changes in cutaneous (skin) areas supplied through the same spinal segment. In 1917, Sir James Mackenzie, a Scottish physician, found that changes in the tone of muscle groups were associated with pathologically affected viscera sharing the same spinal nerve supply. It then should come as no surprise that pain and visceral dysfunction are always accompanied by muscle contraction.

Because the cause of muscle contraction lies in changes in either structure or function, it can be considered a manifestation of stress in the body. Therefore, the clinician may use muscle contraction as a reliable indicator for deviations in normal homeostasis.

The following is a very simple, quick and easy‑to‑perform screening procedure for noting muscle contraction in the body and determining its source. Start by observing the following standing postural deviations: head tilt, low shoulder, low iliac crest, knee flexion, ankle pronation.

Next, check the seated patient for passive shoulder abduction and evidence of Pottenger's saucer or 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.

Turn the patient to the prone position and determine the presence of restricted passive knee flexion and restricted passive dorsiflexion of the ankles.

Once this simple routine becomes second nature, it can be performed in less than two minutes. It can be used anytime you need to determine if a resistant structural problem is actually related to visceral dysfunction. Many chronic headaches, cervical spinal injuries, intervertebral disc problems, chronic recurring low back and sacroiliac problems are prevented from healing because of visceral dysfunctions.

In this series, I will correlate structural and visceral muscle contractions with known physiological and neurological explanations. Particular emphasis will be placed on the autonomic nervous system with its two divisions ‑‑ the sympathetic (fight or flight) system and the parasympathetic system ‑‑ and the very definite correlations that can be made between symptoms and muscle contractions.

(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.)