When the findings on your patients are compared to these pre-conceived visualizations, false interpretations of the palpatory findings are made. Repeated x-ray and videofluoroscopy studies reveal that in fact asymmetry is the rule, that the visualized normal is found only in textbooks. Bony landmarks are not reliable because asymmetry is the rule, and the possibility of structural change is always present. Tissue tensions may be the result of these somatic changes rather than the result of the subluxation complex. Atypical hypertonicity or fullness of the erector spinae mass may be the result of atypical bone development rather than contracture. All these conditions can be differentiated. The important thing to remember is that they must be differentiated.
Mechanical abnormalities and asymmetries are almost always present in the individuals who present themselves for chiropractic care. The great majority of these mechanical abnormalities are caused by structural variations. These structural variations must be taken into consideration in arriving at a diagnosis of the prognosis and management of the patient's care. A diagnosis of subluxation is not adequate. Though it may be semi-accurate, it is far too simplistic and does not adequately portray the complexity of the spinal subluxation complex. The cause behind the "subluxation" must be determined, or treating the symptoms is what you will be doing.
The recurrent type of subluxation should make us suspicious of a basic biomechanical dysfunction brought on by socio-occupational considerations, postural faults or structural variations. The patient must be considered as a whole, rather than as an individual with a bone out of place. All of the factors that are capable of causing aberrant mechanics of the body must be taken into consideration. Their individual effects must be considered are correlated into their total effect. It is possible that multiple structural abnormalities compensate for each other, or that a cumulative effect is established. The total mechanical picture must be conceptualized, visualized, and mentally processed before an intelligent method of treatment can be carried out.
For example: A patient has a pronated subtalar joint and mechanical dysfunction of the twisted osteoligamentous plate. Left long enough, this condition will result in a compensatory internal rotation of the tibia, which in time will result in femoral compensation of the external rotation at the knee joint, and a resultant change in the weight-bearing of the femur in the acetabulum. If neglected, this condition will eventually alter the mechanics of the sacroiliac joints and lumbo-pelvic joint dysfunction will occur. The sacrum, in an attempt to compensate, will cause a lumbar scoliosis to occur which will be compensated by thoracic and cervical scoliosis. The patient presents to the chiropractic office with a long history of headaches. What do you adjust? Where is the biomechanical cause?
An unusual scenario you say? Not at all! It happens every day. However, if you do not look at the entire patient and just treat the symptoms you will miss it (and the referrals too).
Keith Innes, D.C.
Scarborough, Ontario
Canada
Editor's Note:
Dr. Innes will be conducting his next Somatic Components of the Subluxation Complex seminar November 14-15 1992 in Toronto, Ontario, Canada. You may register by dialing 1-800-359-2289.