Diagnosis

Introduction to Chiropractic Physiologic Therapeutics

By Frank M. Painter|November 10, 2012|Chiropractic Care, Diagnosis, Education, Physical Therapy|

Introduction to Chiropractic Physiologic Therapeutics

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 10 from RC’s best-selling book:

“Basic Chiropractic Procedural Manual”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 10: Introduction to Chiropractic Physiologic Therapeutics

The use of physiotherapy and physical therapy to enhance the effects of the chiropractic adjustment in treatment can be significant in many cases. Superficial heat, diathermy, cold, microwaves, ultrasound, ultraviolet rays, galvanic and sinusoidal currents, traction, hydrotherapy, or therapeutic massage and exercise are among the therapies that may benefit the patient when properly applied. These procedures may help to reduce stiffness in joints, relieve tension, relax muscle spasm, and offer many other physiologic benefits.

Special precautions, however, must be observed when treating patients of advanced age. Special consideration must also be given to indications and contraindications, patient sensitivity, intensity, and duration of treatment.

Special caution must be used with patients that have heart and blood pressure problems, renal failure, diminished sensation or circulation, or an inability to tolerate heat or cold. For example, patients with Raynaud’s disease do not tolerate cold. Patients with other circulatory problems do not tolerate thermotherapy because they have less ability to dissipate the heat. Patients with a distinct loss of sensation will not realize if an area is being overheated or even being burned.

A patient’s tolerance cannot be the only guide to intensities and duration of treatment. Frequent checking, both visually for redness and by palpation to determine over heating, must be done during the treatment period. Reasonable examination, monitoring, and care by the doctor can avoid problems in most instances.

INTRODUCTION

Physiotherapy techniques are frequently used preparatory to the chiropractic adjustment to improve function, relieve spasm, minimize pain, and enhance circulation and drainage. They are often used before primary care to relax the patient and condition tissues, and posttherapy to relive pain and prevent deformities resulting from trauma or disease and to maintain what has been gained in treatment. There are also times when it may be considered primary therapy. Rehabilitation objectives are shown in Table 10.1. (more…)

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Diagnosis and Management of Piriformis Syndrome

By Frank M. Painter|September 17, 2012|Chiropractic Care, Diagnosis, Piriformis Syndrome|

Diagnosis and Management of Piriformis Syndrome

The Chiro.Org Blog

SOURCE: J Am Osteopath Assoc. 2008 (Nov); 108 (11): 657-664 ~ FULL TEXT

Lori A. Boyajian-O’Neill, DO, Rance L. McClain, DO,
Michele K. Coleman, DO, Pamela P. Thomas, PhD

Department of Family Medicine, Kansas City University of Medicine,
Biosciences College of Osteopathic Medicine,
1750 Independence Ave, SEP 358,
Kansas City, MO 64106-145, USA.

Piriformis syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction. The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve. The authors review the anatomic and clinical features of this condition, summarizing the osteopathic medical approach to diagnosis and management. A holistic approach to diagnosis requires a thorough neurologic history and physical assessment of the patient based on the pathologic characteristics of piriformis syndrome. The authors note that several nonpharmacologic therapies, including osteopathic manipulative treatment, can be used alone or in conjunction with pharmacotherapeutic options in the management of piriformis syndrome.

From the Full-Text Article:

Epidemiologic Considerations

Piriformis syndrome occurs most frequently during the fourth and fifth decades of life and affects individuals of all occupations and activity levels. [7-12] Reported incidence rates for piriformis syndrome among patients with low back pain vary widely, from 5% to 36%. [3, 4, 11] Piriformis syndrome is more common in women than men, possibly because of biomechanics associated with the wider quadriceps femoris muscle angle (ie, “Q angle”) in the os coxae (pelvis) of women. [3]

You may also want to review

Post-isometric Relaxation (PIR) of the Psoas

Difficulties arise in accurately determining the true prevalence of piriformis syndrome because it is frequently confused with other conditions.

Anatomic Characteristics (more…)

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Multiple Myeloma Presenting as Sacroiliac Joint Pain: A Case Report

By Frank M. Painter|August 6, 2012|Diagnosis, Evaluation & Management, Multiple Myeloma|

Multiple Myeloma Presenting as Sacroiliac Joint Pain: A Case Report

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2012 (Jun); 56 (2):94-101

Danielle Southerst, BScH, DC, John Dufton, DC, MSc, MD,
Paula Stern, BSc, DC, FCCS(C)

Canadian Memorial Chiropractic College,
Division of Graduate Studies,
6100 Leslie Street,
Toronto, ON, M2H 3J1,
(416) 482-2344 x 287;
dsoutherst@cmcc.ca.

Multiple Myeloma (MM) is the most common primary cancer of bone in adults. The clinical presentation of MM is varied and depends on the sites and extent of involvement. Most importantly for chiropractors, the leading clinical symptoms of MM are related to bone neoplasm and may mimic pain of musculoskeletal origin. The following is the case of a 56 year old male chiropractic patient presenting with a 6 month history of sacroiliac joint pain previously diagnosed and managed unsuccessfully as a hematoma by multiple providers. Physical examination, imaging, and laboratory investigations confirmed a diagnosis of MM. The case report describes relevant pathophysiology, clinical presentation, imaging, and management for MM, while illustrating key issues in patient management as they relate to chiropractic practice and the recognition of pathology in the context of musculoskeletal pain.

From the FULL TEXT Article

Introduction:

Multiple Myeloma (MM) is a primary malignancy of bone marrow characterized by clonal proliferation of plasma cells and production of monoclonal immunoglobulin. It is the most common primary bone cancer in adults [1,2] contributing to 1.3% of new cancer cases in Canada and 1.9% of cancer deaths. [3] In 2008, an estimated 6000 Canadians were living with the disease, including 2100 newly diagnosed. [3] Myeloma is slightly more prevalent in males [4-6] and blacks. [4,5,7] The median age at diagnosis is 66, with the majority diagnosed over the age of 60; [8,9] however in a review of 1027 patients diagnosed with MM, 30% were under the age of 60 and the age of diagnosis ranged from 20–92. [8] The most common symptoms reported are those related to bone neoplasm including unexplained backache that is often severe and precipitated by movement. [8,11] These symptoms may motivate a patient to seek conservative care for what is assumed to be a complaint of musculoskeletal origin. This case emphasizes key components of patient management as they relate to chiropractic practice and the recognition of pathology in the context of a patient presenting with pain of presumed musculoskeletal origin.

Discussion:

Pathophysiology (more…)

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A Practical Guide to Avoiding Drug-Induced Nutrient Depletion

By Frank M. Painter|June 25, 2012|Clinical Decision-making, Complementary Medicine, Diagnosis, Drug-Induced Nutrient Depletion, Evaluation & Management, Evidence-based Medicine, Iatrogenic Injury, Supplementation|

A Practical Guide to Avoiding Drug-Induced Nutrient Depletion

The Chiro.Org Blog

SOURCE: Nutrition Review ~ October 2011

By Hyla Cass, MD

A little known, but potentially life-saving fact is that common medications deplete your body of a host of vital nutrients essential to your health. This practical guide will show you how to avoid drug-induced nutrient depletion and discuss options for replacing nutrient-robbing medications with natural supplements.

America has been called a pill-popping society, and the statistics bear this out. Nearly 50 percent of all American adults regularly take at least one prescription drug, and 20 percent take three or more. [1] Our increasing reliance on prescription medications has contributed to the growing problem with nutrient depletion. The truth is that every medication, including over-the-counter drugs, depletes your body of specific, vital nutrients. This is especially concerning when you consider that most Americans are already suffering from nutrient depletion. Additionally, many of the conditions physicians see in their everyday practice may actually be related to nutrient depletion. The good news is that, armed with information and the right supplements, you can avoid the side effects of nutrient depletion, and even better, you may be able to control and prevent chronic diseases, such as diabetes, cardiovascular disease and osteoporosis.

There is more info like this at our:

Nutrient Depletion Page

A Common Scenario

(more…)

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The Subluxation Complex Saves Diagnosis for Texas Chiropractors

By Frank M. Painter|June 14, 2012|Announcement, Diagnosis, Evaluation & Management, Subluxation|

The Subluxation Complex Saves Diagnosis for Texas Chiropractors

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By James Edwards, DC

On April 5, 2012, the Third Court of Appeals of Texas issued a 58-page opinion in Cause No. 03-10-673-CV – the Texas Board of Chiropractic Examiners (TBCE) and the Texas Chiropractic Association (TCA) vs. the Texas Medical Association (TMA), the Texas Medical Board (TMB) and the State of Texas.

According to an April 6, 2012 communication by the Texas Chiropractic Association [1], the case presented three questions for the court:

1) Are the two TBCE rules that allow chiropractors to make certain “diagnoses” valid?2) Can chiropractors perform MUA?3) Can chiropractors perform needle EMG?Here’s what the Court of Appeals had to say in the matter:

Diagnosis

On the two most important issues presented by the TCA, the Court of Appeals upheld the validity of TBCE’s Rules 75.17(d)(1)(A) and (B) (“the scope of practice rules”). The first rule, 75.17(d)(1)(A), permits chiropractors to render diagnoses “regarding the biomechanical condition of the spine and musculoskeletal system,” and lists six typical diagnostic areas as examples of what is within the scope of practice. At the district court level, Judge Yelenosky had struck down that rule, stating that it created an unlimited authorization to diagnose any disease or condition, which, he said, exceeded chiropractors’ scope of practice.

The Court of Appeals disagreed and reversed Judge Yelenosky’s decision. The court found that the TBCE rule does not exceed the scope of practice because the rule limits chiropractors to making diagnoses of the biomechanical condition of the spine and musculoskeletal system.

The second rule, 75.17(d)(1)(B), permits chiropractors to diagnose subluxation complexes of the spine or musculoskeletal system, and lists three examples of what is within the scope of practice. The Texas Medical Association and Texas Medical Board had challenged that rule, claiming that the rule allowed chiropractors to diagnose neurological conditions, and pathological and neurophysiological consequences that affect the spine and musculoskeletal system. At the district court level, Judge Yelenosky agreed and struck down the rule because he found that it expanded the scope of chiropractic beyond what was allowed in the Chiropractic Act.

Again, the Court of Appeals disagreed with District Court Judge Yelenosky. The appeals court acknowledged that a subluxation complex could have functional or pathological consequences that affect essentially every part of the body. But the court found that the rule itself only allowed chiropractors to render a diagnosis regarding a subluxation complex of the spine or musculoskeletal system. That authority, the appeals court held, was consistent with the Chiropractic Act. (more…)

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Forearm and Wrist Trauma

By Frank M. Painter|June 11, 2012|Chiropractic Care, Diagnosis, Evaluation & Management|

Forearm and Wrist Trauma

The Chiro.Org Blog

Clinical Monograph 18

By R. C. Schafer, DC, PhD, FICC

As with most parts of the body, traumatic effects in the forearm or wrist may occur abruptly (eg, fracture, strain, sprain) or be the result of long-term microtrauma (eg, tunnel syndromes, arthritis, entrapment by scar tissue).

BACKGROUND

Screening injuries of the forearm and wrist

Joint Motion Restriction

Restriction in pronation suggests a disorder at the elbow, radioulnar articulation of the wrist, or within the forearm. Restriction in supination is associated with a disorder of the elbow or radioulnar articulation of the wrist. Thickened tissues may cause compression symptoms. A palpable nontender ganglion may be found on either the dorsal or volar aspect of the wrist, perceived as a pea-size or slightly larger jelly-like cyst.

Significance of Tenderness

Tenderness over the medial collateral ligament, which rises from the medial epicondyle, is a sign of valgus sprain. Muscle tenderness in the wrist flexor-extensor group is characteristic of flexor-pronator strain (eg, tennis, screwdriving motions). Tender, possibly taut, wrist extensors on the lateral aspect are often associated with tennis elbow. Tenderness in the first tunnel on the radial side is a common site for stenosing tenosynovitis associated with a positive Finkelstein’s sign. (more…)

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