A Typical First Examination
The first stage of an examination is usually "observation", looking for physical, structural or functional patterns that help direct the later stages of the examination.
These two illustrations show Michael assessing shoulder and hip levels.
The next stage is to observe what happens when movements are introduced and noting faulty motion.
Once identified the Chiropractior will zone closely into areas that are not moving as they should - either because they move too much or because they are not moving enough - checking every joint to identify restriction using "motion palpation".
These coloured beads represent vertebral movement. The red beads are "fixed" - they do not move. The moment any pressure is placed on the beads they do not open out evenly. Instead they force excess movement either directly above or directly below the "fixation", as seen below here on the right.
The Chiropractic adjustment is designed to free the "fixation". You will note in the picture on the left that the three red beads are no longer rigid and stiff - they are now enabled to take their place in the arch.
What we are looking for when assessing individual vertebral movements with "motion palpation" is the "fixation", so often responsible for causing pain and inflammation above or below the "fixed" joint. Once identified by motion palpation the fixed joint can be adjusted and freed, restoring function, easing pain
Motion palpation of the lumbar spine (left) and cervical spine (right)
Orthopaedic tests are undertaken to aid diagnosis to and help direct treatment. Here Kate checks for a "frozen shoulder" and Michael rules out hip arthritis.
Nerve Stretch tests
When a nerve is "trapped" it can be painful to draw the nerve away from its point of entrapment and a sensitised nerve will be susceptible to pain or numbness on compression. A number of tests are designed to highlight the presence of entrapment.
Because the sciatic nerve travels down the leg, when the leg is raised and held straight it draws the individual nerves that make up the large sciatic nerve out from their spinal roots that lie between the vertebrae. If one of the nerve roots is trapped within the vertebra the "Straight Leg Raise" test will trigger excruciating nerve pain quite soon after the leg is raised. Similar tests are done for the femoral nerve and the nerves that leave the neck to go down the arm. Tensioning an inflamed nerve will either meet with pain or, as shown in the Carpal Tunnel Phalens test on the right, with tingling and numbness. There are other tests for nerve irritation in the wrist, elbow and ankle.
Neurological tests can be particularly useful whenever there is radiating arm or leg pain or where there is a suspicion of compression to the spinal cord or individual nerve roots. Deep tendon reflexes, areas of altered skin sensation and weakness of specific muscles can implicate individual nerve roots and the vertebrae that lie above and below them.
These pictures show testing of the medial hamstring reflex on the left, the foot muscles for strength above, and skin sensitivity with a pin wheel below.
Below we see the biceps reflex and finger flexor muscles being tested.
A change in a reflex, a muscle or an area of skin can identify the exact nerve root affected
General Health Status
When relevant, your general health status will be assessed, for example by taking your blood pressure or pulse, palpating your abdomen, or using an ophthalmoscope to study the fundus of your eye.
A chiropractor's training equips the practitioner to screen patients for a number of conditions that may warrant referral to the GP or elsewhere, such as heart disease, diabetes, hardening of the arteries or aortic aneurism.
Sometimes it is necessary to refer for further tests.
The case history and examination may lead to a request for x-rays, an MRI or tests (such as blood or urine).
If you have had recent x-rays we may need to gain access to them. The standard x-ray reports are usually insufficient, as they do not always record the sort of biomechanical information that can be so helpful to us.
If we need to know more about any tests your GP has done you can request these
The working diagnosis arises from the case history and examination and, when necessary, from x-rays or other tests. It enables us to work out the best treatment programme to suit your specific needs and the most likely outcome. There are many types of chiropractic adjustment (manipulation). Some are more appropriate than others in certain conditions, so patients with osteoporosis, for example, would be more likely to receive "non-force" or lighter types of adjustment. Sometimes the diagnosis may direct us to refer you to another health professional or to arrange chiropractic treatment alongside treatment from another healthcare provider.
With the working diagnosis and information gained from the questionnaire, case history, examination, x-rays and tests the chiropractor is ready to formulate a treatment plan and a likely outcome (prognosis). The plan will highlight what we aim to achieve in partnership with you and targets will be set. Genetic and lifestyle factors such as age, diet, smoking, alcohol consumption, exercise, emotional state and home or workplace environment will influence recovery rates dramatically, so patients with the same diagnosis will respond at different rates and in different ways. It is therefore important that the treatment plan is kept under regular review and that you are fully involved in the process. It is also important that you comply with your side of the healing process by following any advice, rehabilitation or exercise programmes you are given. This will maximise the effect of treatment, speeding recovery and reducing relapses.
Report of findings
The report of findings is where we involve you directly in your recovery or maintenance programme. It is essential that you understand clearly what has been happening to your body and how you can return to optimum health by following through the treatment plan together.
Understanding how your spine, pelvis and the other joints in your body work in unison to help you fulfil your day to day tasks, work and leisure activities is important, not only for prevention but also for recovery.
When you know why you need to adapt or change old habits you have the motivation to do so.
Chiropractic adjustments are most effective when you provide the best environment for them to last.
Side effects and risks
Some patients can experience a short period of tenderness or soreness after treatment and this will be discussed with you before we begin. There are risks with any medical procedure and all regulated healthcare professionals are required to make sure that you understand these before you begin. Although spinal manual therapy remains one of the safest medical procedures available, there are very rare, remote risks which your chiropractor will explain to you.
During the early stages, you may feel a mild soreness or discomfort after a visit. It is an integral part of the natural healing process, as your body recovers its flexibility and tone. This reaction is an adaptation by the body to change, following spinal or joint manipulation. It may only last a few minutes or hours. Some patients, if not forewarned, may think they are getting worse but in fact their return to health has already started. After treatment there is a physical change affecting the bones, muscles, ligaments, nerves, blood vessels and cartilage, all of which adapt and undergo the natural healing process.
Sometimes there may be redness or bruising if “deep soft-tissue” therapy has been applied. Disc problems may appear to get worse or “flare up” in the early stages. Where there is already underlying inflammation your symptoms may appear to be worsening. Neck treatment can sometimes give a sense of light-headedness. Occasionally a temporary headache may appear. If, however, you have any concerns, please call your chiropractor.
Once your chiropractor is sure that you accept the plan of treatment and that you understand the risks you will be asked to give your consent and treatment can then begin.
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