Article 3 of 12 Last month. I started this series of articles entitled "Visceral Stress Management" and discussed the body's stress response any time the hypothalamus determines that the body does not have adequate glucose to meet its energy requirements. Any form of prolonged stress will create this problem. It doesn"t matter if the stress is structural, emotional, or caused by visceral dysfunction: the response is always the same and there is always specific involuntary muscle contractions emanating from the cause of stress. So, what do you have to see before you know what to do? Because of the changes in health care in this country, it is imperative that the individual chiropractor begin to incorporate his or her entire basic science education into day-to-day office procedures and move our profession into the twenty-first century. Structure is obviously the first factor in our profession, but visceral function should be equally recognized because the two arc inseparable. Both structural misalignments and visceral dysfunctions cause muscle contraction. Involuntary muscle contractions caused by a visceral dysfunction will cause, perpetuate, and prevent correction of structural problems if they remain undetected. At the conclusion of last months article. I suggested that whatever therapeutic procedure you currently practice, you also should ask the patient to be seated and perform the sixty-second Chiropractic Screening Test for Stress before the patient leaves the treatment room. If you determine that the patient still has a source of stress tliat has gone unrecognized, then I suggest scheduling a special exam at a special time in a special room with a special assistant who will record your findings. This is sure to impress the patient since you will be doing something no one else has ever done. While it may seem unlikely that this could happen in your office. I assure you stress is still present in about two-thirds of patients checked by excellent chiropractors. How confident are you in your examination? Does it educate and inspire your patients? Perhaps the way to enhance your practice and rcim igoratc yourself is to use a special examination and put a new but simple emphasis on it. The purpose of our examination is to identify stress, so what we seek from our examination procedures is a sound, scientific method of determining the source of the patient's problem. Use this procedure on patients who arc not responding well to the present therapeutic approach, or perhaps those you arc in danger of losing. It is often a good idea to begin on family members to become familiar with the routine. The point is to find the originating and continuing cause of the patient's symptoms because once you know the cause, the treatment becomes obvious. The test is easy, convenient, noninvasive. and inexpensive. It is based on finding involuntary muscle contractions within the trapc/ius muscle. Step One - Universal Stress Point We begin by palpating across the top of the shoulders. E\ cry patient knows that area is related to stress. Because the trape/.ius runs upward from T12 to the points of the shoulders and then continues upward to the base of the occiput, it will reflect muscle contractions tliat occur anywhere in the body as it struggles to remain upright against gravity regardless of the cause, whether it is structural, visceral, or emotional. Of course, the muscles involved with ami and shoulder movement arc also involved with breathing—movement of the ribs when inhaling and exhaling. Also, the pleura and diaphragm share sympathetic inncrvation from all 12 thoracic spinal segments, as well as the phrenic nerves from the third, fourth, and fifth cervical segments. Step Two - Passive Shoulder Fixation Once you have ascertained that there is involuntary muscle contraction across the top of the shoulders, check to see the extent to which it affects stcrnoclavicular range of motion. Stand behind the seated patient and reach your left ami around the front of the patient's neck. Then roll your left thumb behind the head of the right clavicle above and behind the stcrnoclavicular articulation. Now your right arm passively abducts the patient's right arm past 90 degrees. The head of the patient's right clavicle should be felt to move posterior and inferior into the patient's chest as the ami reaches and passes 90 degrees. When unrestricted movement occurs without pain, the test is graded as normal and we know there is not yet shortening of the ligaments in that articulation. When movement occurs with some discomfort or restriction, we know there is ligamentous shortening that is graded as mild. We arc simply determining the extent of stnictural misalignment in response to involuntary muscle contractions coming from any source. Restriction may come from the neck, thoracic spine, or rib cage. When movement occurs with an audible "clicking." then grade the restriction as moderate. The restriction may be occurring within the shoulder itself and may be due to a local injury or involve muscle contraction anywhere else in the body. Regardless, the source must be found. Lack of movement at the stcrnoclavicular joint implies a severe restriction and requires further investigation. Then, check the left side to determine if the shoulder problem is bilateral. Never rule out the possibility of thyroid, lymphatic, heart, or respiratory stress in any nontraumatic shoulder problem. i Step Three - Loss of normal thoracic kyphosis Ask the patient to sit up as straight as possible and bend his or her head down. Slide your fingers down the I spinous processes from Tl toward T12. You should feel the "C-shapcd" posterior curve of a normal thoracic kyphosis. Observe if there is a loss of the normal kyphosis and feel for a depression fonned in the middle dorsal spine, usualh between T4 or T5 to T8 or T9. Pottengcr's saucer is not a permanent or static condition. It is transitory and caused by muscle contractions emanating from the abdominal organs, especially those associated with digestive dysfunction, stomach, biliary, pancreas, duodenum, and jejunum stress. These visceral dysfunctions invariably result in low available glucose levels whether functional or reactive. It is interesting to note this is found consistently with muscle-tension headaches. There is that connection with the trapc/ius muscle again. Step Four- Unlevel pelvis when sitting Last, but certainly not least, while the patient is still seated, slide your liands down to the top of the iliac crests and determine if the hips arc level. Of course, we all know that a wallet in a hip pocket may cause a pelvis that is not level. Nevertheless, this may be the cause of recurring back pain and is overlooked occasionally. Be aware that a short (asymmetrical) ilium occurs in 20 to 30% of the population. It is caused by pelvic rotation and is imariabh found in patients suffering from restless leg syndrome. Please dont forget that the involuntary muscle contractions involved here may be from dysfunction of organs in the lower abdomen. If you have cleared your patient's structural issues before pcrfomiing these tests, any positive tests arc an indication of visceral problems that need to be addressed. Next month I"ll continue this discussion of simple rangc-of-motion tests and palpation of peripheral stress points that can reveal hidden sources of involuntary muscle contractions from visceral organs. Dr. Howard Loomis has an extensive background in enzymes and enzyme supplements. He is the founder and president of Enzyme Formulations®, Inc. His knowledge ofphysiolog)>, biochemistry, and enzyniolog)' has made him a sought-after speaker and a prolific writer. Dr. LoomispublishedENZYMES: The Key lo Health in 1999. Contact info: 6421 Enterprise Lane, Madison, WI53719, customerservice(a),loomisinstitiite.com
