May 2007

Determining the side in structural weakness

by Dr. Howard Loomis

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. Every month I try to give you a recipe, a way to work some tried‑and‑true methods of detecting functional disorders. This month I will describe a simple, quick and easy method of determining the patient's side of structural weakness. This, I submit, has more clinical meaning than just checking for the short leg because the side of weakness is often the side of symptoms, past surgery, and injury.

Begin by observing foot flare

With the patient lying in a relaxed and comfortable supine position, stand at the patient's head and observe the angle that the feet form in relationship to the floor. This represents the angle the sacrum forms with the hips. This angle is a very important factor in the body's ability to resist gravity or mechanical stress. After all, the entire weight of the body is normally transferred down the spine onto the front 25% of the sacrum. Any mechanical fault here and the entire body will suffer continual stress. This leads to not only compensatory muscle contractions, but also to mineral deficiencies, particularly calcium.

Record the angle of foot flare as normal, increased, or decreased.

***  Normal Angle ‑‑ Both feet are slightly everted and form about a sixty degree angle with the floor.

***  Increased Angle ‑‑ When both feet are flared or everted beyond the normal angle, the sacrum has tipped forward. All of the normal spinal curvatures are now increased. This creates mechanical stress in the lumbo‑sacral area of the spine and often manifests itself with symptoms associated with parasympathetic dominance.

***  Decreased Angle ‑‑ When both feet are vertical, or close to vertical, the sacrum has tipped backward. All of the normal spinal curvatures are now decreased or straightened. This creates mechanical stress throughout the spinal and particularly in the upper cervical area. This stress often manifests as symptoms of sympathetic dominance.

Determine the lower extremity weakness

Regardless of the angle formed by the feet when the patient is supine, one foot may lay out more than the other (everted). This is the side of weakness in the patient's body and has great significance in our system of analysis. As mentioned before, this often is the side of the patient's symptoms and even past surgery. The most everted (turned‑out) side is the side of stress. This would be true even if the angle of one foot was vertical and the other slightly inverted. The side of weakness is on the side that is most everted; in this case, vertical.

Measure arm length

Next, have the patient extend arms over the head. Grasp both of the patient's arms above the wrist and lightly traction them towards you. The elbows should be straight and the arms parallel to the floor. If this is not achieved, there is muscle contraction and possibly ligament shortening in the shoulders or elbows. If one or neither elbow straightens, you should suspect shoulder involvement and check for range of motion and neurovascular involvement. I described those methods in previous columns.

Now, bring the palms together and measure the relative length of the arms to each other. If the arms are the same length, the test is negative. If the elbows straighten to the same angle and there is a difference in the length, you should suspect muscle contractions affecting the thoracic spine. Many times this is caused by a digestive disorder and involves the diaphragm which is directly connected to the cervical spine via the phrenic nerve. In such a case, there will always be an alteration of the spinal curvatures in a lateral direction, and the patient will exhibit a loss of normal thoracic kyphosis or the so‑called Pottenger's Saucer.

The significance of this was discussed in last month's column. Recall that the astute clinician will consider visceral stress involving the lymphatic, circulatory, or respiratory systems as well a thyroid involvement. Obviously, all could perpetuate muscle contractions and structural problems in thoracic spine and rib cage.

Finally, observe for a left or right side of structural weakness, that is, both foot flare and short arm are found on the same side. A much more chronic and complex problem is presented when foot flare and short arm are on opposite sides. In such a case, begin examining the pelvic organs for visceral involvement as well as the lower extremities, pelvis, and lumbar spine for structural involvement.

Remember, the secret of your success will be 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.

(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.)