Every chiropractor needs a few simple time-saving procedures that can prompt a course of action, direct the need for further examination, and improve therapeutic outcomes.
When I entered practice, my mentor passed on many pieces of timeless information from his bag of tricks. You could refer to these as “rules of thumb.”
He taught me that we all find procedures we like. And when used at just the right time, these methods prove to be incredibly successful.
Afterward, every time you see that exact set of circumstances, you can apply the same procedure and it works again. You accumulate these little secrets throughout your professional life and use them as needed— regardless of your routine.
Here is one procedure to consider whenever you are dissatisfied with a patient’s progress and especially when the patient is unhappy. Patients are usually somewhat responsible for a chronic reoccurrence of the same subluxation pattern. Quite often, a chiropractor is told he or she “didn’t quite get it” because, after the last treatment, “it” came back. When this happens, have at the ready what I call the standing postural screening.
Make no mistake: You can perform the procedure in less than a minute without an extensive re-examination or a separate appointment. Run this screening after each adjustment for at least one day, and you’ll be amazed to find that, without it, about two-thirds of patients would have left the office under structural stress.
Any deviations from normal found during this evaluation will cause the perpetuation of chronic reoccurring subluxations often overlooked in routine chiropractic adjustments.
Standing postural screening
I begin my biomechanics seminars by asking the audience, “What do you have to see before you know what to do?” The question always fails to elicit a response. I say, “The answer is any deviation from normal.”
It’s surprising that many chiropractors do not routinely screen patients’ standing posture. This practice is simple: Ask the patient to stand and assume a comfort- able posture. Start your observations at the feet and ankles and progress up the legs to the knees. Then check hip level, shoulder level, and finally side-of-head tilt.
The process takes about 10 to 15 seconds. Since the patient is attempting to remain upright against gravity, any inequality between left and right will cause misalignments and subluxations, and prevent their correction.
Patient self-evaluation and reactivation
Perhaps the most important aspect of this procedure is that it’s done in front of a full-length mirror so patients can
see the deviations. Explain how any of the observed variances may apply to their individual symptoms. Teach patients to check their own posture in front of a mirror at home, so they know when to schedule an adjustment before their symptoms reoccur.
You’ve been trained to evaluate posture, so here are some guidelines you can use to help educate patients.
High side: Muscle contraction can usually be palpated along the base of the occiput and mastoid due to an atlas PS subluxation. Soreness occurs on the spinous processes of C7 to T4 and possibly on the head of the clavicle.
Low side: Pain and tenderness will present in the temporalis and masseter muscles on the low side and can be associated with an axis PI subluxation.
The low shoulder is usually the site of structural dysfunction, regardless of the location of the symptoms. The cause of dysfunction can come from anywhere in the body—especially the pelvis and legs.
Palpate all possible related muscle contractions. Digestive and bowel problems are often responsible for nontraumatic shoulder problems.
Palpate the infraspinatus fossa for soreness and muscle contractions. When found, this indicates subluxations of the upper ribs. Look for pain at the rib angles and in the rhomboid muscles. This finding is almost always involved with thyroid and upper extremity problems.
If you find a winged scapula, palpate the serratus anterior muscles between the lateral ribs. This condition is involved with subluxations at C5 to C7 and may be caused by chronic lung congestion.
Regardless of your adjusting procedures, think of the high iliac crest as indicating the side of anterior-inferior sacral subluxation with posterior rotation of the ilium. Initially, before compensation, the side of the supine short leg will occur on the side of the posterior ilium. As the situation
becomes chronic, it produces continual compression on the knee and may eventually lead to cartilage damage and knee replacement.
Side of knee flexion
A knee that cannot straighten in the standing position usually indicates degeneration of the knee cartilage. The opposite knee may be considered as the side of the long leg and may lead to future hip replacement.
Ankle pronation and orthotics
Both arches falling evenly (pronating) is not as much of a problem as when one falls more than the other. This condition must be corrected with orthotics.
If left uncorrected, ankle pronation acts as a continual stress to the body with every step a patient takes.
When one ankle (internal malleoli) is lower, you should suspect the possibility of the pelvis rotating anterior on that side to assist the body in remaining upright against gravity.
Quite often the patient will exhibit one side of the pelvis that’s higher than the other when sitting. This may be referred to as “hemipelvis,” which can be related to symptoms originating from organs in the lower abdomen.
Take the opportunity to screen everyone who comes through your practice. This standing posture procedure is quick and may lead to increased referrals and improved patient compliance.
Howard F. Loomis Jr., DC, is a 1967 graduate of Logan College of Chiropractic. He ran an active general practice in Missouri for 25 years. He is a member of the postgraduate faculty at Logan and is the founder and president of Enzyme Formulations Inc. and the Loomis Institute of Enzyme Nutrition. He can be reached at 800-662- 2630 or through loomisenzymes.com.