July 2009

Visceral dysfunction

by Dr. Howard Loomis

Previously, I discussed the possibility that visceral dysfunctions can, and do, perpetuate structural problems that often prove resistant to chiropractic care (June 2009, The Chiropractic Journal, p.1, "Why some adjustments don't hold"). That is, the same subluxations continually reoccur in the same patients. The secret for helping these people is not found in our technique but rather by determining the cause of the problem, which may not be musculoskeletal in origin. For the purposes of this column, I will only refer to identification of possible underlying visceral dysfunction and will not be discussing a complete chiropractic examination.

A logical place to start is to include postural analysis in your examination. It surprises me to find that so few chiropractors perform this quick and easy procedure during each visit. This takes only about 30 seconds yet yields an incredible amount of useful knowledge.

First, recall that all stresses manifest as muscle contraction regardless if their source is structural or functional. Any visceral dysfunction will produce involuntary contraction in the muscles that share the same spinal innervation as the involved organ. This is a good place to define muscle contractions versus muscle spasms. According to Dorland’s Illustrated Medical Dictionary, muscle spasms have a sudden and violent onset, while involuntary muscle contractions are not sudden and certainly not violent, but they do involve reduced range of motion.

Posture review

If you haven’t thought about postural analysis lately, let’s review posture and what it can tell you quickly and inexpensively. We will quickly scan for head level, shoulder level, lateral bending, hip level and lateral shifting, knee flexion, and ankle pronation. Then we'll check for hip level with the patient sitting.

Head Tilt -- This usually involves misalignment of the Occipito-Atlantal condyles and cervical flexion-extension problems. 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.

Low Shoulder -- The low shoulder is usually the side of dysfunction and symptoms. But remember that non-traumatic shoulder complaints can originate anywhere in the body. For example, when the low shoulder is on the same side as the low ilium, we might suspect a significant leg deficiency of more that 3/8 in. When the low shoulder is on the side opposite a low hip, we might expect a leg deficiency of less than 3/8 in.

However, many functional problems such as bowel irregularity or lymphatic and respiratory congestion are often involved. Another frequent source of shoulder symptoms is digestive inadequacy and the appearance of a Pottenger’s Saucer. Loss of rib excursion on breathing will produce shoulder symptoms and painful stress points within the Infraspinatus fossa.

Lateral Spinal Curvatures -- Convexity of the spine will appear on the side of the low ilium and leg deficiency. These are always quite obvious to casual observation. However, many such fixations are present that are not obvious until you have the patient bend laterally at the waist and observe the normal “C” shape appearance of the spine. This maneuver will expose many hidden causes of structural and functional problems.

Low Ilium -- A low ilium can result from many causes, but invariably is on the side of high weight on a bilateral scale. Leg deficiency is probably the most common and can be caused by a dropped arch in the foot or a fracture in the lower extremity. Hip rotation may be severe enough to produce an un-leveling of the pelvis.

Lateral Pelvis -- A lateral shifting of the pelvis is a frequent sign of sacro-iliac involvement, but the key to resolving this problem is often seen at the level of the 5th cervical. The works of both Gravel and Reaver are convincing in this regard.

Flexed Knee -- Unfortunately, this phenomenon is frequently overlooked. The flexed knee is 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 lumbo-sacral instability. It is interesting to note that studies have indicated that 40% of the population has a second metatarsal that is longer than the first. This is known as Morton’s Syndrome and is responsible for many orthopedic problems. This causes the foot to roll off the second toe instead of the larger, and structurally stronger, big toe, resulting in lateral heel and medial sole wear.

Hemipelvis (low iliac rest in the sitting position) -- This can have many causes and should be easily corrected with adjustments. Medical studies indicate that 20-30% of the population needs an ischial lift to level the pelvis when sitting, yet this is arguably the most overlooked cause of many visceral problems stemming from the pelvis including Restless Legs Syndrome. Also, the implications in scoliosis are evident.

Conclusion

Having conducted this quick postural exam and identified the most obvious structural misalignments, in future columns I'll begin to examine each individual spinal section for muscle contractions and misalignments that may be related to visceral dysfunction.

(Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison, WI 53719-1116 or by phone at 800-662-2630. Visit his website at http://www.loomisenzymes.com.)