Mastering the chiropractic initial exam

The initial exam allows you to establish the need for care.

It also demonstrates your interest in the patient’s daily activities, including work environment, posture, exercise and diet.

All communications with the patient should reinforce the powerful relationships of structure, function and health, and remind them that chiropractic care improves all three. As you perform your exam, share your findings, both positive and negative. The initial exam provides the perfect opportunity to reinforce your use of orthotics and other supports or adjuncts.

All patients come with different backgrounds, problems and expectations; however, there are three fundamental learning styles. Psychologists have categorized these as visual, auditory, and kinesthetic. No one falls completely into one of the categories, but there is strong agreement that the best way to educate is to emphasize the predominant style while including all three.

Fortunately, because more than 65 percent of your patients learn through visual examples, you can make simple demonstrations during your exam that will reassure and reduce any resistance to accepting your care.

Admittedly, most of your patients expect a symptom-based approach to care. You may need to explain how areas away from the pain may actually be causing their problems. Chiropractors are more likely to consider how a headache, for example, could be the result of a bad pillow, a need for eyewear, or even flat feet.

If there are medical conditions in play, they must be addressed immediately. More commonly, though, postural imbalances create distortions in the neurological and musculoskeletal systems. In fact, many of the painful conditions DCs treat are an indirect result of instabilities in the feet and lower extremities.

Should I always examine the feet?

It is more than a coincidence that both low-back pain and foot problems affect 80 percent of adults. Furthermore, most patients with foot problems experience little or no pain in their feet. The feet are very flexible, and often adapt to these problems.

Rather than experiencing foot pain, patients present with pain in the knees, hips and spine. Your ultimate success will depend largely on your ability to correlate structural deficiencies with the patient’s signs and symptoms.

Don’t confuse asymptomatic with non-subluxated

Unfortunately, a patient’s need for custom orthotics may often be considered only after an inadequate response to chiropractic care. Patients with an obvious need should be casted and fitted for orthotics early in their treatment plan. Consistently using orthotics with your adult patients will enhance your adjustments and speed recovery.

Therefore, in addition to a spinal evaluation, ask patients about problems in their ankles, knees and hips. Every new patient exam should also include an evaluation of the patient’s gait, shoes and feet. Objective evidence obtained through observation and functional testing supports the need for care and reassures patients that you have considered every possibility.

You should introduce your exam by saying something like this:

I provide corrections to unhealthy joints. Additionally, I support this care with nutrition, orthotic support, and rehabilitative exercises. Each one of these aspects of care will be based on your needs, which I will establish by performing a thorough examination.

As 80 percent of adults have foot and back problems, evaluating for custom-made orthotics during the initial exam gives you an effective tool against the consistent and destructive patterns of spinal misalignment right from the start.

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