Seems like today everything is described by initials–in part due to email and texting shortcuts–including how children with special needs can be labeled, ADD (Attention Deficit Disorder), and DD (Developmental Delay) to just name a few. Even many anatomy parts or common chiropractic phrases are better known for their initial description than listing the whole word, such as ACL for anterior cruciate ligament or CMT for chiropractic manipulative therapy. A commonly used term in our history taking of a patient involves their "activities of daily living" or better known as "ADL’s."
It is important that we ask our patients about their ADL’s for two important reasons. First, to have a better understanding of what their personal lifestyle involves. Second, it helps in our assessment to identify possible biomechanical stresses that are caused from the biomechanics they use or do not use when performing their job, hobbies, etc.
Often new patients will present to our office with no idea of why they hurt. They have no history of an accident, fall or trauma. In this scenario, we have to rule out other contributing factors like diet, possible pathology, socioeconomic factors as well as alterations in normal movement patterns or biomechanics. These are all factors that can occur over time and result in causing vertebral subluxation complexes. We consider these types of injury mechanism as repetitive stress syndromes or microtraumas. Let’s look at a case study where multiple ADL’s contribute to the neuro-musculoskeletal problems of a 25-year-old secretary, who is a mother of two young children and is training for her first half marathon.
Mrs. Y enters our office with complaints of lower back pain and left knee pain. The pain is progressively worsening with time and gets worse as the day goes on. It is beginning to affect her job and half marathon training, not to mention her attitude! She can give no history of trauma or previous injuries. After our evaluation, which includes a thorough case history, examination, X-rays of the spine and both knees, we determine she has multiple levels of spinal and pelvic subluxations. There are no measurable disc or joint degenerative changes in the spine or knee.
We recommend a treatment plan that includes chiropractic manipulative therapy or CMT (there are those initials again). During our examination, we determine Mrs. Y showed some weakness in the hip musculature, so we introduced a series of hip strengthening exercises using flexible tubing resistance bands. We also demonstrated some stretches for the piriformis and psoas as additional patient exercises. A digital foot scan of her feet indicated dropped arches, while the colorized version of the scan showed more lateral weightbearing on her left foot.
Considering all of the above, here are some other factors from her ADL’s we might consider:
• Is her work station ergonomically correct?
• Does she get in and out of her swivel chair correctly, or does she twist in and out of it with poor posture? Does her office chair support her frame structure?
• Are her computer and phone positioned in places that match her posture and positioning?
• Is she using good mechanics when lifting and taking care of the children?
• Does she create excessive twisting and rotational movement when vacuuming and dusting?
• Is her bed more than 10 years old? Does it sag or feel lumpy? Does she need new pillows? If so, we could recommend a custom-made pillow to properly support her when she sleeps.
• What about her car (better known as the family bus)? Does she have the seat in a posture that does not stress the spine? Does she take advantage of the lumbar supports?
• Does Mrs. Y run on surfaces that could create repetitive stresses, like unevenly paved roads or up and down hills?
• Does she follow a recommended training regime used for a half marathon or does she just run at the same pace and same mileage?
• What about her shoes? Does she wear shoes that are designed to match her specific foot structure and are they of good quality? Are they wearing down? It is recommended that runners change their running shoes on an average of every 500 miles.
• Could she benefit from wearing custom-made, flexible orthotics? If so, explain how custom-made orthotics can help enhance her athletic performance as well as reduce joint pain caused by running.
As we noticed from the above information, there is a lot to consider when evaluating ADL’s. As a doctor of chiropractic, we understand the importance of reducing vertebral subluxations and allowing the nervous system to flow uninhibited. Our clinical experience tells us that many factors contribute to the development of vertebral subluxations. It is easy to determine those that result from a direct trauma. It is a little tougher to determine what other stresses are contributing from our everyday activities or ADL’s.
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.