Website report February 2008

Expanding your scope of practice

Last month, in the January report 2008, I gave you a quick and efficient questionnaire so
that you could identify conditions in your patients that they may not associate within your
domain. The two reasons for using the questionnaire was to help identify all the causative
factors involved with their chief complaint and secondly to uncover other conditions you
could treat, hence creating the need for more service by you.
Chiropractic practices are diminishing in the USA for more than one reason, but the
narrowing of our scope by are own poor thinking and procedures are a big part. I expect
25% of my new patients to have early O.A. of the hip joints revealed by a positive Fabere
sign. Even a mild positive is very significant, as hip, hypo mobility leads to degeneration
after years of eccentric dysfunction. The hip dysfunction causes abnormal movement in
the lumbar spine which in turn causes compensation in the whole spinal, closed,
kinematic chain.
I saw motion x-ray studies in 16 mm, film format in 1962 presented by Dr. Fred Illi of
Switzerland. He showed patients walking on a treadmill that had a positive Fabere sign.
They had compensated in the lumbar spine by becoming hyper mobile at the lumbo sacral
joints and formed a C curvature to one side on alternative steps. Once the hip
manipulations restored a normal range of motion the 2nd series of motion film showed the
lumbars remained steady and no curvature formed.
Dr. Illi stressed, that we always had to consider if we were treating a primary dysfunction
or a compensation dysfunction. We need to often treat the cause of the cause of pain.
Many researchers have stated, “If you treat the pain source you are probably not going to
the real cause of the inflammation. In Dr. Illis’ hip dysfunction patient, the compensated
low back was where the patient complained of pain.
So often, when I have a headache patient with severe sub occipital muscle tension and
upper cervical joint dysfunction, the real cause is in the upper thoracic region, first rib,
costo transverse, joint dysfunction and not so uncommonly a sacroiliac dysfunction.
On the first visit examination, I like to palpate and test the range of motion of all the
joints. How else can you discover the faults in the locomotor, closed kinematic, chain?
Patients never complain that one is too thorough.
Often patients will say, “No wonder I haven’t got well, No one found that hip problem,
before”.
I adjust the hip as demonstrated on the videos and add a figure four stretch to be done 4
or 5 times a day. The patient sits on a chair and crosses their right ankle on to the top of
their left knee and leans forward while pushing the right knee down and away towards
the floor. This stretch is held for 30 seconds and the patient breathes out slowly.
S.A.I.D. of this stretch causes a gradual increase in the soft tissues restricting hip
movement.

Recently, Dr. Ove Lind of Sweden showed me some interesting video of a patient hyper
extending the lumbar spine in order to rise from leaning forward. He then fully
manipulated and stimulated the ankle joints in this patient, especially to restore the severe
loss of dorsi flexion of the ankle mortise joints. He adjusted the joints and then used a
Thuli drop mechanism to repeatedly recoil the mortise joint. His rational is to cause
afferentation that has been missing, back to the brain. When he retested the action of
bending forward and rising back up, the lumbo pelvic rhythm was normal no hyper
extension occurred.
Dr. Brett Winchester an MPI Instructor demonstrated at the November Advanced
Seminar, a test for poor dorsi flexion of the ankle. Patients with this dysfunction rotate
their foot, toe outwards, in order to step down a step. For example a right ankle dorsi
flexion, hypo mobility causes the right foot to toe out when the left foot is stepping down.
In my little rehab area, I have steps that I ask the patients to step down from.
These patients often walk with their toes out to the side more than 15 degrees.
Don’t miss these significant dysfunctions in the kinematic chain of locomotion.
The patients that answer questions of organ dysfunction present a problem unique to us.
Since we don’t manage pathology diseases of the organs, we need to discern if the
pathology is reversible. We also need to ascertain if we are restricting the patient from
receiving a better, therapeutic approach. There are therapeutic and ethical questions to be
answered.
I recently, successfully helped a young woman return to normal from a severe case of
Irritable Bowel Syndrome. I not only adjusted her but I got her to read “The Stress of
Life” by Hans Selye, M.D. I counseled her in some significant lifestyle changes and I got
her to take some supplements that swung her urine pH from 5 to 7.5.
Her condition was reversible and her previous treatment was ineffective. A holistic
approach was ethically correct and like many others she responded well. She referred two
patients within a week of getting better. She understood my adjustments were designed to
lessen the facilitation of the sympathetic nervous system. When I adjusted her upper
thoracics, she got a flushing (hyperemia) of her neck and ears. I had her lay still for a few
minutes to feel the “relief” of the tension occurring and the heat the adjustment caused. I
made her “feel” the reaction to the adjustment. She knew something was happening; she
didn’t have to wonder if something happened.
Make sure your patients experience a feeling of something has changed after you
adjusted them. Often, on re motion palpating after the adjustment I make sure they can
feel the change I can feel has occurred in their range of joint play motion. This is the
reason I use two stools to palpate a patient sitting. It separates the diagnostic palpation
from the adjusting table palpation and adjustment.
Patients like it when I re motion palpate and point out the changes. I end by saying; we
shall see how that region is on Wednesday.
Wednesday starts with my opinion of how the changes improved a little, a lot or none at
all. None means it was secondary compensation that had to recur. A little means we
persevere and a lot means we move on to the next most fixated area.
Treatment is always a series, not only to restore the dynamic function of the closed,
kinematic system but to maintain that normal function, long enough for decompensating
to occur. Patients understand this fact; I often wonder why so many doctors are confused
about this issue. They want to discharge patients when the pain is relieved, well before
the tissues can change, that were in the dysfunctional motion unit. Even a monthly check
up is better than being discharged. In this way you can review their home rehab program
and lifestyle changes for a few months.
Healing is truly an inside job, just not as simple as above down and inside out, like our
forefathers hypothesized.

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