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Palpation:
The Art and Science of Chiropractic Diagnosis |
Now that you have an idea of how a chiropractor views
the spine and the importance of the spinal joint complex,
the next step is to understand how a chiropractor examines
the spine. For this, an uncomplicated case study is
useful.
Patient
Case:
A
39-year-old amateur weekend gardener has pulled one
too many weeds and experiences painful spasms across
the low back with debilitating stiffness. After two
days of persistent pain, she makes an appointment to
see her chiropractor. The chiropractor takes her history,
finds that standard neurological findings are normal,
and x-ray studies show no fracture. There is no evidence
of a bulging disc or any unusual complications.
The
chiropractor proceeds to use a number of chiropractic
diagnostic procedures to determine what went wrong with
the gardener. Having developed the analogy of the moving
picture in explaining the dynamic spine, we can say
that the chiropractor is comparing that picture with
a new dynamic model: the unhealthy and injured spine
that the patient presents.
Some
of the indicators the chiropractor uses to build the
new picture include the location and character of the
patient's pain, gait and posture, general range of motion,
muscle tone, muscle strength and balance. Especially
important is a chiropractic diagnostic procedure called
spinal palpation.
Spinal
Palpation
Palpation is the process of examining by means of touch.
The art of spinal palpation is the first procedure a
chiropractor learns in school. It is an art the chiropractor
continues to perfect throughout his or her career. Palpation
is not the only way a chiropractor determines where
and how to adjust or manipulate the spine. It is however,
the chiropractor's central diagnostic technique.
Static
and Motion Palpation
Static palpation involves the palpation of tissue surrounding
the spine for pain or tenderness, as well as feeling
for lack of tissue compliance or tightness. With experience,
a chiropractor can gain vital information through direct
touch.
In
motion palpation, the chiropractor examines each complex
spinal joint to analyze the degree to which it may lack
proper motion. This highly-skilled maneuver requires
the examiner to have a mental picture and tactile knowledge
of a spinal joint's normal motion. Normal motion is
compared with the feel of the joint being examined as
it is moved through its range of motion.
As
a joint goes through its range of motion, there is extra
play to that motion called the end play. An easy way
to illustrate end play is to demonstrate using wrist
motion.
For
example, straighten your wrist with the palm up. Draw
your hand forward to flex the hand toward the wrist.
At about 90 degrees, you will reach a normal stopping
point. Now make the wrist move just a little more toward
you. You will reach an absolute stopping point where
the wrist cannot move any farther. That little extra
distance you have made your wrist move is called the
joint's end play.
When
the muscles of your wrist work to bring the hand toward
you, they depend on end play in the joint. If your wrist
was locked or fixated, the muscles would tug against
the fixed joint and become inflamed.
Spinal
Joint Subluxation
In examining the amateur gardener with low back pain,
the chiropractor has asked the patient to sit on the
adjusting table. Standing behind the patient and using
both hands in a series of gentle motions, the chiropractor
examines the low back joints one by one, taking each
joint through its five ranges of motion to determine
if any joint has become locked or fixated. Specific
lack of spinal joint motion is one important aspect
of what chiropractors call a subluxation.
If
you have been to a chiropractor, you have probably heard
the term subluxation. When the chiropractor reports
his findings to the patient, he explains an injury or
lack of proper function to a particular spinal joint
as a subluxation of the spine.
A
subluxation is a disturbance in the spinal joint's function.
The term subluxation describes a set of abnormal spinal
joint inter-relationships that is not yet fully understood.
These inter-relationships include the structural, mechanical,
chemical, neurological, hormonal, and circulatory spinal
joint components. While not an identifiable 'thing'
like a fracture or a wound, it is a useful organizing
principle for chiropractic research and clinical practice.
Determining
the Chiropractic Listing
Returning to the examination of the amateur gardener's
lumbar spine, the chiropractor finds a locked joint
in the low spine. Let's say it is the spinal joint formed
by the 4th and 5th lumbar vertebra (L4-L5) and the joint
is locked on the right-side in a range of motion called
extension.
When
the chiropractor moves the L4-L5 joint into extension
on the right-side using motion palpation, there is no
end play in the joint. The chiropractor determines from
the character of end play, as well as other diagnostic
indicators, that the fixation is caused by injury to
a muscle. The specific lesion in this case is at the
L4-L5 joint and its specific characteristics make up
what is referred to as the listing.
Part 1: Chiropractic
Care
Part 2: Chiropractic
Diagnosis
Part 3: Understanding
Chiropractic
Part 4: Chiropractic
Spinal Adjustment
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