Dr. Cooper was probably the coolest person I have ever known. When he walked into a room everyone took notice. He had a striking appearance. He wore dark suits, was always tan and his hair and goatee were silver.
As my college music teacher for private lessons, he liked to have me play music sight unseen and constantly challenged me to do better. The challenges were fun during the lessons, but less fun in a real-life situation. Dr. Cooper provided me one of those real-life situations during my second music jury.
A “jury” was a panel of three music professors, one of which was the professor who taught your private lesson. You had to perform for the panel to receive your final grade for the lesson class. The professors critiqued your performance and could ask you questions about the music performed or any anything else you had studied during the semester.
During my performance the three professors left their positions behind the table where they were sitting and stood behind me. They watched the music and listened as I played. It went well and I was glad it was over. At least I thought it was over.
The panel commended my performance and then Dr. Cooper said, “Now comes the fun part.” He took the music off the stand, turned it upside down and said, “Now play it upside down from the end backwards.”
I am sure I looked at him as though he was kidding. The other two professors began to laugh but Cooper was serious. I knew from his sadistic grin he was not kidding. I looked at the music and realized I had to reverse all of the rhythms; I took a deep breath and started playing. I played the first line without trouble. He then stopped me and told me I passed the test.
At first I didn’t know if I should be upset about the curve he threw me or to be pleased with myself. Later I was pretty happy. It may seem like a minor challenge in life, but I have thought about that day frequently over the years. I have thought about the stress of the situation, pulling the rabbit out of the hat and the confidence Dr. Cooper had in me to do what he asked. He helped me have confidence in myself. It was a wonderful lesson from a wonderful teacher.
So, what does this have to do with chiropractic? It helped me adjust my thinking about the use of Spinal Pelvic Stabilizers (custom-made orthotics) in my chiropractic practice.
Throughout chiropractic college we were bombarded with the principle “above down inside out.” It is a principle we have lived by. However, practice showed me it could not cover every situation I encountered. There are other principles that must be considered in providing appropriate patient care.
One of these principles (actually it’s a law of nature) is gravity. Gravity works from the feet up. Another principle is that information is received from the periphery of the body and moves from the periphery inward and up. Proprioception is an example. These principles were discussed in chiropractic college but not to the degree that “above down inside out” was.
Some chiropractic spinal techniques do note the contribution of the lower extremities to spinal conditions. Gonstead Technique, Barge’s Tortipelvis and Barge Scoliosis Techniques all advocate heel lifts under certain circumstances. Their recommendation are based however, on line drawings of lumbopelvic x-rays. Analysis to determine the lower extremities’ contribution to pelvic obliquity is secondary. Only select segments of the kinetic chain are looked at in these methods.
When considering above down inside out, gravity, proprioception and the kinetic chain, how is it possible to look at one without the other? Shouldn’t a doctor be able to work through the diagnostic and treatment processes from either end, knowing them forward and backwards? If the doctor does not consider each of these, is it the best possible situation for the patient?
Ultimately, these questions are answered by the doctor’s choice in style of practice. Some choose to provide treatment for the body regions that are symptomatic while others provide a whole body approach. The whole body approach requires the doctor take the four factors discussed above and others into consideration for examination and treatment.
When you start practicing, be sure you consider every aspect of the patient in your evaluation and treatment. I recommend trying examination and treatment upside down from the end backwards (starting from the ground up). You will be surprised at the benefits to your patients and the increased satisfaction you feel as a doctor.
