The Deductive Protocol: Advanced Clinical Verification for the Frustrated Student.

The Deductive Protocol: Advanced Clinical Verification for the Frustrated Student.

1. Posture
2. Active posture
3. Motion palpation
   1. Coupled movement
4. Myotome assessment
5. Therapy Localization
6. Challenge
7. Adjust
8. Reassess

The following is a roadmap in deductive reasoning as it pertains to the modern chiropractor and chiropractic student and is intended for the practitioner who understands nuance and values precision. 

Step 1.  Posture. 

Look at the person.  Stand them up and look at them.  Just like we are more than the sum of our parts, humans are more than a spine to be palpated.  Dr. George Goodheart said, “Look with eyes that see”.  He understood the difference between the two.  Dr. David Leaf said, “If you look at someone long enough, they will show you what is wrong”.  Look at the person who is coming to you for help. 

Don’t look at them as a skeletal system.  Look at them as a biomechanical marvel.  A beautiful integration of bones, cartilage and muscle bathed in fluid.  And just like chiropractors move bones, muscles move bones.  Those muscles need nerve supply, but they also need an anchoring mechanism.  When that anchoring mechanism is disturbed, the brain is no longer perceiving clean communication from the body.  There is a problem with the light bulb and not the electrical panel feeding the lamp.  There are only two options, the bulb has come loose or burned out.  Either way, moving the circuit breaker switch back and forth will do nothing to correct the problem.

If we see a shoulder high on the left, let’s think deeper into the action of muscles and how those muscles affect the perception of the body in space.  The left latissimus or lower trap is not firing or being anchored.  There may be a reciprocal tension in the upper trapezius due to the levator scapulae inhibition.  If the rhomboid and levator scapulae are both affected, there may be a problem with the dorsal scapular nerve.  Let’s begin to think bigger.

Step 2.  Active posture.

People move.  And their bodies are supposed to move in certain ways.  If their body is not moving correctly or effectively, this can (and will) influence what you do.  Your classic chiropractic spinal adjustment will not last longer than that person can get to their car.  So, are you wasting your time?  The patient’s time?  This also increases the likelihood of applying forces to the body that are not necessary, which, by definition, is an injury, whether the injury is big enough for the brain to trigger a pain response or not.

Have them bend forward and ask a few questions.  Can they touch their toes and not bend their knees?  Do they shift their weight effectively?  Is there a uniform spinal curve?    Have them move into extension.  Do we see a uniform spinal curve here?  Is their pelvis “dumping” and their spine compressing at L5?  All this matters.  These are but a few options.

Step 3.  Motion Palpation

Chiropractors should know spinal movement patterns better than anyone on the planet.  After we look globally, we should be able to have a good idea of where the patient’s problem is.  From here, take the patient through a segmental movement screen with an understanding of what the spine is doing within that movement.  This is getting us closer to the root of the issue.  Accuracy here is key.

Step 4.  Myotome Assessment

When dealing with nerve problems, we need to look for direct nerve involvement.  What better way to do this than looking at the muscle that is correlated with the specific segment that we have identified as the potential problem.  Granted, myotomes blend.  C5 doesn’t just innervate the deltoid to assist in shoulder abduction.  It has some spillover into C6 with elbow flexion, but the primary movement is toward deltoid function.  If our perception is leading us toward C5, test the deltoid as there may be nerve root involvement. 

A pinched nerve is a lay term and should be used as such.  Impingement is a more accurate statement which not only involves the biomechanics of the disc and facet but also involves swelling of the tissue around that area due to inflammation.  This is a CHEMICAL problem.  If the patient is eating garbage they consider food, this could be the cause of the problem, and the chiropractor should be able to decipher structure vs. chemistry.  D.C. stands for “doctor of cause”.  Find the cause.

The subluxation can, but does not have to, create myotomal disturbance.  This can lead us to the question that many have brought up, but few have answered.  If you can’t see a subluxation and can’t feel a subluxation, it seems that there should be a better way to assess for said subluxation than simply taking an x-ray to look at it and palpation to feel for it.  This leads us to…

Step 5.  Therapy Localization (TL)

This is a term coined by Dr. George Goodheart and should be used by more chiropractors to find subluxation.  This is a very simple process.  Have the patient touch an area of the body and test a muscle.  TL inhibits facilitated muscles and facilitates conditionally inhibited muscles.  TL tells us WHERE a subluxation exists.

How does this happen?  To answer this question, we must go back to the sensory cortex and understand the difference between touch and feel.  Our fingers touch and our brain feels.  The brain’s perception is dependent on the individual’s experience in the physical environment and emotional development.  Two people can touch the same thing and have a completely different perception of what they are touching. 

When a subluxation exists, there is a disconnect between body and brain.  In other words, the body part being touched is in a different area of space than where the brain’s perception of it exists.  If we touch a subluxated area, our fingers relay information to the sensory cortex and if that area doesn’t match, this short circuits the nervous system and “weakens” a muscle.  Now we have confirmation.   

If we are palpating an area of the spine and perceiving a potential problem there, TL the area and test a muscle.  If there is a problem there, the muscle will inhibit.  Remember, we cannot see or feel subluxation.   Now that we have confirmed interference within the nervous system, we must decide on what to do to correct the problem. 

Step 6.  Challenge

TL tells us WHERE a problem is.  Challenge will tell us WHAT it is and what to do with it.  When we push a subluxated vertebra in the direction of correction, as with TL, it inhibits intact muscles and facilitates inhibited muscles.

The idea behind the challenge mechanism as it pertains to the spinal subluxation is the surrounding musculature, i.e. intrinsic muscles.  When a segment is subluxated, the muscles are holding it in its position to avoid further displacement.  When it is pushed in the direction of correction, the intrinsic muscles, due to their facilitation, overreact and pull the vertebra further into subluxation, momentarily inhibiting an intact muscle.

Now we have confirmation of subluxation and its listing.

Step 7.  Make your correction based on confidence, not an assumption.

Step 8.  Just because an adjustment does or does not make noise, does NOT mean that what you did corrected the problem.  The muscle test allows us to verify whether what we did had the desired effect.  Gone are the days of wondering if what we did corrected the subluxation that we identified and pounding on the spine to make noise when none was had initially because the “crack” makes us feel like we accomplished something.

No longer do we have to try to see and feel a subluxation alone.  With the small amount of movement necessary for the vertebra to create neurological interference, it seems we should have something more accurate to lean on.

Life itself is your teacher, and you are in a constant state of learning.”    -Bruce Lee

DD and BJ Palmer and the others that came after had constantly sought more accurate means of “diagnosing” the subluxation.  Chiropractic has too often substituted ideology for verification, and if the profession wants to mature, it needs better deductive and empirical methods.  Just like the Palmers, Gonstead and Thompson, Goodheart has elevated the chiropractic profession.  And in the end, the muscle test takes chiropractic theory and grounds it in the realm of empiricism.