March 2007

Quick structural screening assessment

by Dr. Howard Loomis

This month, I will outline a rapid screening procedure for evaluating structural problems. I believe that regardless of your technique and office procedure, if you will do this test on a few patients each day for a week, you will find many "hidden" problems that may be hindering your patients' progress back to normal function.

We all see patients who continually present some structural complaint that requires episodic attention yet permanent alleviation is never achieved. Successful doctors treat the cause of the problem, not the symptoms. They are able to quickly and accurately determine the source of the patient's stress, devise a plan of treatment, and confidently convey their findings to the patient. They specialize in helping problem cases ‑‑ the ones no one else can help. They solve these cases by identifying the specific causes of disorder, discomfort, or disease that have not been identified elsewhere.

What tests can you perform in your office that other practitioners do not? It surprises me to find that so few chiropractors perform a quick and easy postural analysis during each visit. A visual inspection is relatively quick and you don't even need a plumb line.

Recall that all structural problems manifest as muscle contraction and reduced range of joint motion. The body struggles constantly to maintain balance against gravity. In this exam we seek to find the lowest level of reduced structural integrity.

With the patient standing in a relaxed and normal posture, quickly scan for:

***  Head Tilt ‑‑ When palpation reveals painful muscles on the high side, the patient is usually experiencing stretch‑related symptoms such as muscle tension headaches. Painful muscle contractions of the low side are usually related to compression‑type symptoms such as vertigo and migraine headaches.

***  Shoulder Level ‑‑ The low shoulder is usually the side of dysfunction. Perhaps the most puzzling of all symptoms patterns are vague shoulder complaints when there is no history of trauma. It is important to remember that these can originate anywhere in the body.

***  Hip Level ‑‑ A low ilium can result from many causes. Hip rotation is probably the most common, but it can be caused by a dropped arch in the foot or a fracture in the lower extremity.

***  Knee Flexion ‑‑ The flexed knee can be associated with cartilage damage and even condyle damage on the convex side of a scoliosis. A valgus deformity may appear on the side of greatest ankle pronation. Knee flexion will appear on the side opposite a leg deficiency and produces a shearing‑type wear‑and‑tear in the hip joint above it.

***  Ankle Pronation ‑‑ Ankle pronation results in a "toeing out" of the foot when walking. This is of critical importance when treating a lumbosacral instability. This is also a good time to check for Morton's Syndrome, a second toe that is longer the big toe. This is responsible for many orthopedic problems and is overlooked in about 40% of the population. How many are in your practice?

Now have the patient sit down and check the following points:

***  Iliac Crest Level (Hemipelvis) ‑‑ Studies indicate that 20‑30% of the population needs an ischial lift to level the pelvis when sitting. The implications for structural problems are evident but how often do you check for it?

***  Pottenger's Saucer ‑‑ Have the patient bend their head forward and then lean forward at the waist. Slide your fingers down the thoracic spinous processes and take note of a loss of normal kyphosis between the shoulder blades (T4 to T9). When the saucer is encountered, press headward on each of the spinous processes. They will be painful and there will usually be at least three vertebral segments involved.

***  Passive Shoulder Abduction ‑‑ Stand behind the seated patient and examine the right shoulder by reaching your left arm around the front of the patient's neck. Roll your left thumb behind the head of the right clavicle at the sternoclavicular articulation. Use your right arm to passively abduct the patient's right arm past 90 degrees. The head of the patient's right clavicle should be felt to move posterior and inferior into the patient's chest as the arm reaches and passes 90 degrees.

***  Grade the test as normal, mild, moderate, or severe based on the amount of lost range of motion.

Conclusion

What do you have to see before you know what to do? Remember, the secret of your success is determined by how quickly and accurately you can determine the source of your patient's stress, devise a plan of treatment, and confidently convey your findings to the patient. Despite being so quick, this examination will yield a great deal of valuable information.

(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.)