June 2007

Abdominal palpation

by Dr. Howard Loomis

I have been discussing an easy to learn and apply system of examination that I refer to as "The Second Factor" in chiropractic. The exam is designed to indicate when visceral dysfunction is the underlying cause and perpetuates musculoskeletal problems, preventing their correction and healing. We know that structure and function cannot be separated when attempting to find the cause of a patient's symptoms. Anatomy strongly influences physiology and vice versa. Of course, they are unquestionably linked neurologically.

Last month, I discussed how to identify the patient's structural side of weakness. It is interesting to note how often their symptoms, history of previous injuries, and even surgery correlates with the same side as the structural weakness.

Friberg reported in 1983 ("Clinical Symptoms and Biomechanics of Lumbar Spine and Hip Joint in Leg Length Inequality," Spine 8(6):643‑651) that it is important to correlate the patient's symptoms to the type of biomechanical stress:

A. MUSCLE pain can occur from either stretching on the long leg side or compression on the short‑leg side.

B. DERMATOMAL symptoms most often result from torsion stress, and if located on the side of disk bulge, surgery was not usually necessary.

C. VISCERAL symptoms indicate an organ unable to adequately perform its role for maintaining homeostasis. Any visceral dysfunction produces muscle contraction and trigger points in the muscles that share spinal innervation with the stressed organ/tissue.

Organs located on the side of the structural weakness are the ones that are primarily affected in any syndrome. For example, a left‑sided structural weakness might involve the heart, stomach, spleen, pancreas, and descending colon. While a right side of structural weakness might involve the liver, gallbladder, ileocecal valve and ascending colon.

Other organs or parts affected, contralateral to the structural pull, are involved to a lesser degree.

Previously, I have outlined a time‑honored method of identifying possible visceral involvement based on chiropractic palpation of the spine, identification of spinal involvement, palpation of the peripheral areas innervated from that spinal area, and correlating this with the patient's symptoms. Corrections are then made by:

1. Adjusting the subluxation which removes the muscle contraction at the spine and periphery.

2. Supplying the proper nutrition to the stressed organ/system.

3. Removing the habit‑pattern that originated the challenge to homeostatic maintenance.

This system of practicing clinical chiropractic is scientifically sound, based on accepted anatomy, physiology, and neurology. It is easily and quickly integrated into any practice, and above all it allows the doctor to be incredibly accurate in diagnosis ‑‑ identification of the cause of the patient's symptoms.

This system is vastly different from the one mandated by politico‑economic entities which demand that practitioners list the patient's symptoms and place a name on them. The name then denotes the drug(s) to be used to suppress those symptoms.

Because the symptoms of digestive disorders are so ambiguous, identifying the organ of involvement is almost impossible using the medical model. Take gas and bloating, for example. Are they caused by inadequate acid in the stomach? Flow of bile to emulsify the food? Enzyme production from the pancreas? Bicarbonate secretion by the pancreas to activate the enzymes? Sugar‑digesting enzyme production by the small intestine? Intestinal flora?

You can readily see the problems of using symptoms to make a differential diagnosis of digestive disorders. In addition, medicine lacks objective laboratory testing for making an accurate appraisal of the situation. This is the major reason so many over‑the‑counter remedies are available. Billions of dollars are spent each year on drugs to suppress the symptoms of heartburn, excess acid, bloating, gas, and other symptoms of indigestion. But they do not and cannot restore normal function; in fact, they all will produce side effects in the long term.

Using the chiropractic model as a means of differential diagnosis not only makes the job much easier, it is much more accurate. In future columns, I will discuss the following areas of involvement:

***  Biliary function and muscle contraction inferior to the right anterior costal arch.

***  The gastrointestinal mucosal lining and muscle contraction in the epigastric area.

***  The pancreas and jejunum and muscle contraction under the anterior left costal arch.

***  Muscle contraction in the midgastric area and the occurrence of gas and bloating.

***  The spleen and muscle contraction in the left flank within the transverse abdominis muscle.

***  The liver and muscle contraction in the right flank within the transverse abdominis muscle.

***  The small intestine and muscle contraction in the periumbilical area of the abdomen.

***  The kidney and muscle contraction in the below posterior costal arch within the erector spinae muscle.

***  The ascending colon and muscle contraction associated with the ileocecal valve and right McBurney point.

***  The descending colon and muscle contraction associated with the valve of Houston and left McBurney point.

***  Muscle contraction within the pyramidalis muscle that is associated with the organs of reproduction.

***  Muscle contraction above the pubic symphysis that is associated with the urinary bladder.

(Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison,WI 53719 or by phone at 800‑662‑2630. Visit his website at http://www.loomisenzymes.com.)