The initial patient exam starts with the pedal foundation and how it is involved in spinal stability
The initial patient exam and doctor’s report I utilize with new patients evolved over a period of years after my graduation from chiropractic college in 1980. I had the incredibly fortunate opportunity of meeting and working for Monte Greenawalt, DC, DABCO, while I was a chiropractic college student in the late 1970s. Very early in my chiropractic education, Greenawalt taught me the importance of the pedal foundation and how it was involved in spinal stability.
So, with that in mind, I am going to outline the initial patient exam and briefly explain my treatment protocol of a typical chiropractic patient.
Patient history and the initial patient exam
Like every chiropractor, I have my patients fill out a HIPAA-compliant health history form. After that, I consult/interview the patient to obtain more details and clarify any questions I may have from the history. Then I administer the initial examination that I originally developed in the late 1980s when I practiced in Las Vegas, Nev.
One of the most important components in my initial patient exam is to examine the patient starting from the ground up. I begin my exam using a digital foot scan that will determine any degree of pronation or supination and whether it is symmetrical or asymmetrical. This is very important as this can directly relate to lower extremity and spinal dysfunction and symptomatology.
Since pronation of the feet is the most common pattern seen in adults, I also utilize a series of reliable visual indicators present in the patient with the typical pronation pattern. These include a foot flare/toe out stance, Achilles tendon bowing, calluses under the second, third, and fourth metatarsal heads, and posterior lateral heel wear on the patient’s shoes.
After that, I observe the patient in a standing posture to determine the levels of the feet, knees, hips, shoulders and head. I then perform the typical range-of-motion analysis on the cervical, thoracic and lumbar spine, noting any restrictions and/or pain.
I also use the typical appropriate orthopedic checks, which include Cervical Compression and Distraction, Jackson’s, Bechterew’s, Kemp’s, Nachlas, Ely’s, Hibb’s, Yeoman, Lasegue’s and FABER tests. I also check deep tendon reflexes for the cervical and lumbar areas.
I then take A/P and lateral X-ray views of the lumbopelvic and cervical areas unless contraindicated. As a chiropractic student, I was also influenced by Russell Erhardt, DC, DABCR, one of the first diplomats in radiology in the chiropractic profession. He had a saying, “To see is to know. To not see, is to guess.”
Radiographic measurements and report of findings
As we were all trained in radiology, I first rule out any pathologies, etc., that would be contraindications for chiropractic care. Then, I measure several chiropractic radiographic measurements. These include:
1) femur head height
2) lumbosacral angle
3) Ferguson’s Gravity line
4) measurement of cervical lordosis
Based on the information obtained in this initial patient exam, I create a report of findings in PowerPoint format. In this report to the patient, I present visually-based information on the patient’s unique combination of feet, knees, hips, pelvic, thoracic and cervical alignment.
I explain to the patient basic postural considerations and the ramifications of crossing the legs when sitting, slouching when sitting and sleeping on the stomach. I also discuss that when I adjust their feet, it will not “hold” for very long since the primary stability of the arches in the feet is ligamentous in nature.
We know that the plantar fascia will plastically deform and foot adjustments do not hold for very long. A functional support for the three arches of the feet that allows normal/optimal ranges of motion of the feet and blocks excessive motion is my recommendation to patients.
Presentation of recommendations
I then present my recommendations, which in most cases include flexible function orthotics, plus a series of chiropractic adjustments. A series of basic rehabilitative exercises is utilized on my patients to balance and strengthen areas of the spine and extremities.
My adjusting protocol involves full spine diversified adjustments along with an analysis of indictors and appropriate adjustment of the feet, knees, hips, wrists, elbows and shoulders. I explain to the patient that I am going to utilize a whole-body adjustment protocol based on indicators and not necessarily their symptoms.
Even the first chiropractor, D.D. Palmer, was well aware of the clinical significance of adjusting extra vertebral articulations, particularly the feet. In his book, “The Chiropractic Adjuster,” he states, “Chiropractors adjust any and all of the 300 joints of the body, more particularly the joints of the spinal column.” Along with, “Chiropractors are the first to adjust the bones of the foot for the relief of corns.” He also stated, in the same book, “Why adjust the lumbar for displacements of the foot?”1
MARK CHARRETTE, DC, is a graduate of Illinois State University and Palmer College of Chiropractic in Davenport, Iowa. He is the owner of Charrette Chiropractic in Flower Mound, Texas. He is the author of “Chiropractic Extremity Adjusting; Charrette Adjusting Protocols,” and has produced an instructional video series on extremity adjusting. As a member of the Foot Levelers Speakers Bureau, he has taught more than 2,000 seminars on chiropractic techniques. Learn more about upcoming events and other Foot Levelers speakers at footlevelers.com/continuing-education-seminars.