The diagnostic process of a patient’s disorder begins with the recording and interpretation of the patient’s medical history. Thus, the initial interview and consultation with the patient is of utmost importance. It will direction the examinations and tests that are to follow. Every measure of observation that will substantially profile the patient is employed and recorded. A systematic and thorough physical examination is conducted using the methods, techniques, and instruments that are standard with all health professions. In addition, the doctor of chiropractic will include a postural and spinal analysis, an innovation in the field of physical diagnosis and examination.

Background

The chiropractic physician uses the standard procedures and instruments of physical and clinical diagnosis, and he is well acquainted with the need for differential diagnosis. Diagnostic radiology, especially as it pertains to the skeletal system, is a primary clinical diagnostic aid in chiropractic and has been since the early 1900s.

In addition, doctors of chiropractic are knowledgeable in the standard and special clinical laboratory procedures and tests usual to modern diagnostic science. Facilities for roentgenography (x-ray), thermography, electrocardiography (ECG or EKG), and electromyography (EMG) are standard among many other technologic advancements. Each accredited chiropractic college has a laboratory licensed to carry on clinical laboratory examinations, including such fields as cytology, chemistry, hematology, serology, bacteriology, and parasitology.

After experiencing a diagnostic evaluation from a doctor of chiropractic, many patients report that it was the most thorough examination of their lifetime. The reason for this is that the chiropractic physician views each patient as an individual who has been subjected to both unique outside and inside forces, who is interested in both correction and prevention, and who is interested in the preservation of both the quantity and the quality of life. Thoroughness is a necessity to achieve such goals.

Overview of the Diagnostic Process

Any professional therapy administered ethically, professionally, and legally must be based on the doctor’s diagnosis of the patient’s condition. That is, the diagnosis must direct the treatment. By understanding why the doctor does what he does during the diagnostic process, the CA will be in a better position to answer patient questions. Diagnosis (determining the cause of the patient’s complaint) involves the use of inductive and deductive logic. This process can be divided into two major divisions: data gathering and data interpretation (Table 3.1).

Once the initial collection of facts has been completed, the patient’s complaint will tend to fall into one or more of 13 general etiologic classifications:

(1) traumatic (extrinsic or intrinsic),
(2) inflammatory,
(3) neurologic,
(4) vascular,
(5) endocrine
(6) metabolic,
(7) neoplastic,
(8) degenerative,
(9) deficiency,
(10) congenital,
(11) allergic,
(12) autoimmune, or
(13) toxic.

Each of these general classes contains hundreds of specific disorders. The suspicions obtained at this point will then be either confirmed or rejected by the results of further examination and test data until the likely cause remains.

The above process is aided by determining whether the patient’s symptoms arise from physiologic, structural changes, or mental/emotional changes. This process is often called problem group analysis.

1. Functional:   a physiologic disorder; a pathophysiologic disease process without overt structural changes. Symptoms resulting from physiologic changes arise from:

   • Increased function: eg, nerve irritation such as in hypertrophy, spastic paralysis, anxiety, tachycardia, diarrhea, pain, edema, fever, or articular instability.
     
     
   • Decreased function: eg, nerve pressure such as in atrophy, flaccid paralysis, depression, bradycardia, constipation, numbness, dehydration, hypothermia, or articular fixation.
     
     
   • Altered function: eg, nerve irritation or compression such as in convulsions, tremors, arrhythmia, various visual disturbances, paresthesiae, and aberrant articular movement.

2. Structural:   an organic disorder, with or without signs of overt pathology. Symptoms resulting from structural changes arise from:

   (a) bone and joint infection with resultant soft-tissue reactions, subperiosteal calcification, decalcification, bone destruction, and infiltration processes;
   (b) congenital anomaly;
   (c) deformity—witnessed as abnormal changes in angularity, displacement, or loss of continuity;
   (d) degenerative process;
   (e) endocrine and metabolic imbalance;
   (f) tumor (malignant or benign); and/or
   (g) trauma.

3. Mental/emotional:   a neurosis or psychosis; a predominantly psychosomatic or somatopsychic disturbance. Symptoms resulting from mental/emotional changes may be the result (or cause) of either a physiologic or structural lesion.
   
   It is often difficult to draw the line between functional and organic illness. In functional disorders, there is undoubtedly a degree of chemical and intracellular alteration preceding gross structural (organic) manifestations. In addition, nontraumatic altered structure and its gross signs and symptoms are inevitably preceded by altered function and its more subtle symptoms. A clinical sign or a symptom is never an isolated phenomenon. It has multiple interrelationships, some physiologic and some psychologic, that can be of a major or minor importance.

Chiropractic treatment methods are determined by the scope of practice authorized by state law. In all areas, however, these methods do not include the use of prescription drugs or major surgery, thus avoiding the dangers therein. Essentially, treatment methods include the chiropractic adjustment when indicated and, according to the doctor’s judgment, such ancillary services as necessary dietary advice, nutritional supplementation, physiotherapeutic measures, and professional counsel.

The most characteristic aspect of chiropractic practice is the release of one or more hypomobile (fixated) and possibly subluxated spinal or extraspinal articular surfaces by making a specific predetermined adjustment. The purpose of this correction and its determination is to normalize the dynamic relationships of segments within their articular range and thus associated neurologic, muscular, and vascular disturbances.

Physiotherapy and Physical Therapy

Physiotherapeutic methods and procedures are frequently used as adjunctive therapy to enhance the effects of the chiropractic adjustments. Such procedures may include the use of diathermy, galvanic current, infrared and ultraviolet light, ultrasound, paraffin baths, hot or cold compresses, acutherapy, hydrotherapy, heel or sole lifts, foot stabilizers, and other commonly used modalities. Taping, strapping, and other forms of minor surgery are sometimes used in injuries of the spine or extremities. Neck, lower back, elbow, knee and ankle injuries may require supportive collars or braces to enhance the effects of corrective treatments during recuperation to help tissue healing and strengthening.

Nutrition.   The adequate intake and assimilation of essentials nutrients is necessary to maintain health, and tissue demands increase during illness and stress. Vitamin, mineral, enzyme, and tissue (eg, protein) supplementation can, if professionally supervised, serve to prevent the onset or assuage the existence of some types of dysfunction of the nervous system and other tissues. If deemed necessary in case management, dietary regimens and nutritional supplementation are often advised.

Patient Counsel.   Rehabilitative exercises, as a physical therapy, comprise an important aspect of professional counsel to aid recovery and prevent further strain. An assistant may be asked to record in a patient’s entering data a few words that would describe the patient’s common exercise level. Descriptors are shown in Table 3.2

Advice is often given in such areas as dietary regimens, physical and mental attitudes affecting health, personal hygiene, occupational safety, life-style, posture, rest, work, and the many other activities of daily living that would enhance the effects of chiropractic health care. Chiropractic is truly concerned with the total individual: the patient’s health, welfare, and survival.

The spinal subluxation and the extraspinal mechanical lesion are yet only partially understood. Because of their observed importance in degenerative diseases and functional disorders, the chiropractic profession has sponsored and will continue to sponsor research in this area so that we may know more of the implications involved which have been demonstrated successfully with millions of patients in chiropractic offices since the turn of the century. It is unfortunate that the subluxation, and its attendant soft-tissue trauma, is one of the most commonly missed diagnoses within the healing arts. It is not only a mimic of many diseases, it also can be a causative or contributing factor in a variety of disorders.

Mechanical disorders and their functional alterations are probably the most common of man’s ills today. Yet, this is not unusual when we consider that the body’s response to gravity is a constant strain in the upright posture. Such stress must have a negative effect on the healing powers of our nature. We should be ever mindful that the musculoskeletal system comprises more than 60% of our body’s total mass, yet this 60% is often overlooked within other healing arts.

While chiropractors emphasize the importance of the correction of spinal and extraspinal mechanical lesions, no practitioner believes that these are the sole causes of disease. However, clinical chiropractic has shown repeatedly that neurologic aberrations originating from mechanical lesions are a contributing or inducing factor in many more dysfunctions than commonly realized. As has been shown, when combined with poor nutrition, pollutants, physical and emotional overstress, germs, trauma, drug-related weaknesses, poor habits and addictions, and other common debilitating factors, such mechanical lesions become an important consideration far too often overlooked.

Pain and Preventive Care

In matters of health, a warning signal matters a great deal. Pain is such a warning. As nature’s early warning signal, it is a message that tells us that our body is not functioning properly—that something serious may be wrong with our health. Pain of any kind is an alarm that nature uses to signal where there is a health problem deserving attention. It is just as foolhardy to do no more than kill the pain with a pill or injection as it would be to silence a fire alarm and fail to seek its cause. To affect proper care, the cause must be treated—not just the symptom.

      COMMON COMPLAINTS

Headaches are the most common complaint encountered in the healing arts today, and a common cause of headaches originates from a vertebral articular disorder in the spine. It is important that such mechanical lesions be recognized by a trained chiropractic physician. Unfortunately, sufferers of headaches are too often offered a generalized diagnosis such as sinus trouble, migraine, cluster headaches, and so forth. Because chiropractic care is attentive to the neurologic implications involved, headache sufferers have frequently found relief under chiropractic care where other forms of therapy have failed.

The second most common complaint is that of backache. Here again, lumbago, sacroiliac strains, and disc injuries are usually of a musculoskeletal nature having neurologic overtones. It is important that the cause be recognized and cared for before permanent damage is done. Because chiropractic care recognizes the structural/functional relationships involved, the profession has earned a respected reputation in handling cases of both acute and chronic back pain.

Remember that many pains remote from the spine originate from a spinal disorder. In the same manner, many pains that appear to be situated within the spine originate in some distant tissue. Differential diagnosis in such conditions requires a thorough holistic approach—an approach demonstrated under modern chiropractic care.

      RESISTANCE TO DISEASE

Health science would be much simpler if a single disease could be attributed to a single cause. But this is not so. We all live in an environment of potential bacterial and viral invasion, but only a small minority of us become infected. Even many of the most virulent strains of pathogenic organisms do not infect every person exposed. Bodily resistance, acquired or inherited, and many other factors combine to decide whether an invading organism will result in noticeable infection.

Human ecology and economy are complex considerations. The cause of disease is not singular, neither is the response to disease singular. Thus the logic of a health care that considers a person as a total being. Any illness affects the total person, and any disease is multicausal. The total person is affected because illness is not a thing, it is a process.

Chiropractic’s emphasis on the importance of body resistance is a contribution that has yet to realize its full potential. Every person is an individual from his fingerprints to his structure, functions, responses, adaptability, habits, and addictions. All logical theory and therapy should be directed to recognition of individual differences and supportive of one’s peculiar nature.

It is unfortunate that the health sciences traditionally have not emphasized the importance of the nature of health as it has the nature of disease. In recent years, L. J. Rather, MD, a Stanford University pathologist, reminded the International Congress of Logic, Methodology and Philosophy of Science that: “If we measure interest by activities rather than by protestations, physicians have been and are, for the most part, as little interested in health as soldiers in peace.”

Sports Injuries

Because of chiropractic’s emphasis on structural/functional relationships in health and disease processes, it is logical that there is much attention within the profession given to therapeutic kinesiology. One purpose of the ACA Council on Sports Injuries and Physical Fitness is to seek improvement in the prevention and correction of sports and recreational problems. Because of chiropractic input, counsel, and ingenuity, several contributions have been made regarding protective gear and shoes in contact sports, athletic health maintenance, and therapy and enhanced rehabilitation after injury.

While chiropractic contributions in this area have been made for many years, the public press has brought increasing attention to the profession’s unique approach. Much publicity surrounding chiropractic care with Olympic and professional athletes has been given in recent years. Football, baseball, basketball, tennis, golf, volleyball, and most other sports can be thankful for chiropractic’s advanced approach to the care of sports injuries.

Prenatal and Postnatal Care

During pregnancy, there is a natural change within the mother’s pelvic structure along with an accompanying change in weight distribution. Health disorders such as headache, backache, leg pains, and lower extremity circulation disturbances often can be attributed solely to the strain on the portions of the neuromusculoskeletal system involved. In association with regular obstetrical care, periodic chiropractic spinal analysis and adjustments throughout the course of pregnancy show excellent clinical results in either reducing or eliminating such disorders as well as easing the labor of delivery.

Spinal examination and necessary correction after delivery is a positive step toward preventing potential lower back and sacroiliac disorders that may have been initiated during pregnancy or delivery. Correction of these often minor disorders at this time may serve as a positive deterrent against possible structural/functional gynecologic problems of later years.

Pediatric Care

The strain of delivery plus the disproportionate weight of the child’s head upon yet to be fully developed neck structures may result in insults to the child’s upper cervical vertebrae, effecting a variety of dysfunctions. Chiropractors recommend a spinal examination of the child shortly after birth so that proper correction can be made if problems exist. Only a chiropractic physician has been trained to make such determinations. Clinical records show that chiropractic pediatric examination and care during the postnatal period have positive influence on reducing the possibility of colic, digestive sensitivities, allergies, and other common dysfunctions in the newborn—as well remove predisposition to common childhood diseases.

Since it is impossible to restrain a normal child from participating in the many activities that may cause stress and strain, the correction of faulty body mechanics early is important. Active children are particularly prone to spinal subluxation because they are energetic, impatient, and have an innocent disregard of caution. Spinal disorders often are the result of twists, sudden turns, awkward lifts and postural positions, and shocking body contact and jolts during play and sports. If not corrected, spinal problems may lead to interference with normal function and body mechanics contributing to severe illness.

Chiropractic is an exciting profession, and serving as a chiropractic assistant offers a stimulating and challenging career. This chapter has briefly described an overview of chiropractic health care. Most briefly, the profession’s implementation of diagnosis, therapy, rehabilitation, and counseling have been explained. In addition, some important aspects of general practice and specialized interests have been defined so that the reader will have a better understanding of the profession. This will serve as a foundation for further study. In the next chapter, the language of the health-care professions will be explained.