Utilizing Range-of-Motion Testing to Improve Adjustive Specificity
TECHNIQUE
This test gives the chiropractor some basic insight into whether the patient's primary subluxation is in the cervical spine or sacroiliac region.
John Wohar
DC
MOST CHIROPRACTORS PRACTICING today were exposed at one point or another to the Derifield Leg Test in their education. Unlike most orthopedic and neurological tests, the Derifield test at least gives the chiropractor some basic insight into whether the patient’s primary subluxation is in the cervical spine or sacroiliac region.
For example, if the patient presents with a left short leg that balances or crosses over to appear long at 90 degrees with the patient’s head rotated to the right, we were instructed that this indicated a cervical subluxation, most likely posterior on the left side. We then were instructed to palpate down the interlaminar joints on the left side to identify the muscle bundle or tenderness indicative of the primary cervical subluxation. We would then make a contact on that specific cervical lamina and deliver a modified cervical Diversified thrust to that segment, and voila, the leg length discrepancy would vanish.
Similar algorithms existed for the Derifield + and Derifield - tests, which indicated that the patient’s problems were at the other end of their spine in the sacroiliac region. This was very useful as a baseline testing protocol. However, I will ask what would appear to be the follow-up question if one ascribes any degree of validity to the Derifield test at all — namely, why only test cervical rotation? Why not test the patient in flexion, extension, and lateral flexion? Let me back up a bit and explain.
Sometime between 25 and 30 years ago, a female patient came in for her monthly adjustment and asked, “Why is it that when I flex forward to stretch my hamstrings at the gym, one leg goes longer than the other?” I replied, “Dunno, but that’s really interesting!” Being from Missouri (actually California, PA), I went on to say, “Show me!”
She sat up on the adjusting table and flexed all the way forward reaching for her ankles. What do you know,? One leg went at least an inch longer than the other. Also, being one who tries to develop a muscle test for every situation, I sat her back up to 90 degrees and tested one of her deltoid muscles for strength. The muscle tested strong, so I had her flex forward again, and I retested the same muscle, which now tested very weak.
Holding her in that flexed position, I proceeded to therapy localize (or just touch, for you non-AKers) every segment in her lower back, starting with her sacrum. One of the lower segments brought strength back to her deltoid, so I challenged that segment for vector of correction or line of drive. Using my Activator or Arthro-Stim, I adjusted that segment while she was in the forward flexed position, and her legs balanced instantly. I thought to myself, “Now that was really interesting. I wonder if that will work in any position.”
For the rest of that day and ever since, I started examining every patient in multiple positions. This is facilitated in the lumbar region by the fact that I have been using Leander tables as my primary adjusting table since the mid-1980s, which have the ability to move into flexion, extension, and lateral flexion or any combination of these positions.
“For the rest of that day and ever since, I started examining every patient in multiple positions.”
Over the next few years, I was able to identify predictable patterns of muscle imbalance and subluxations, which accompanied changes that occurred in various ranges of motion. The next step in this technique was to identify organ reflexes that appeared to influence recurrent subluxation patterns if left uncorrected.
I consider myself more of a clinical researcher than an institutional researcher. I observe changes in muscle length and/ or strength and then search for ways to correct those changes. I have come to believe, after 44 years in the field, that 80% of the recurrent subluxations we see in practice have an organ component that needs to be addressed.
Is that so hard to believe, considering the deplorable state of nutrition in our country today? When you are grocery shopping, just look at the shopping carts of the people around you and see the processed junk foods that they are taking home to feed themselves and their families. Is it any wonder that so many of your patients cannot “hold” their adjustments? We talk about toxicity as being one of the “three Ts” of the causes of subluxation, but what are we doing to address the toxic state of most of our patients?
Let me leave you with this clinical pearl. With your patient supine, stretch your patient’s outstretched arms overhead and observe whether they are even or not. (For you SOTers, this would be akin to the psoas muscle test).
If they are even, instruct the patient to rotate his head to the left and then to the right. Observe for changes in arm length. If no change is observed, then have the patient laterally flex their head to the left and then to the right. Observe for any changes once again.
Let’s say that one arm shortens with the head laterally flexed to the left. I would then move to the left side of the patient and test their left deltoid. The muscle will test weak in the position that the arms change length.
Keeping the neck in LLF, retest the deltoid muscle strength as you touch each cervical vertebra, starting at C2 on the left. One of the segments, usually a lower cervical, will bring strength to the weak muscle. Proceed to adjust that segment with the neck in LLF. Be gentle and specific; use your Activator if you are more comfortable with instrument adjusting. The arms will balance 90% of the time.
For the 10% that don’t, there is a second segment involved, usually an upper thoracic. I will then challenge the upper thoracic for LOG and then adjust it as if it were an anterior subluxation but stressing either a L-to-R or a R-to-L LOG holding the patient’s head in the LLF position as I deliver the thrust. This will clear any remaining discrepancy in arm length.
Follow the same procedure if the imbalance occurs with either LROT or RROT. Obviously, if the imbalance occurs with LROT, the subluxation will be on the right side.
In most of these situations, there will be organ involvement, but that is a topic for a future article. However, ask yourself, when a person goes to bed feeling fine but wakes up the next morning with mild to excruciating neck pain, did that person really just “sleep wrong”? Is it entirely possible that the night before they most likely “ate wrong”? You decide.
Do I completely understand the exact neurological mechanisms that account for these observable changes in muscle length and strength that I have witnessed and corrected for the past 25+ years? No, I don’t. I will leave that to the institutional researchers to sort out someday. I just know that they are quite common and are easy to clear with a little practice.
As a practitioner who is still amazed daily by the workings of innate intelligence, I liken myself to St. Anselm, who said with regard to faith many centuries ago, “I do not seek to understand in order to believe, but rather I choose to believe in the hope that one day I will come to understand the deep mysteries of our faith.” Add dynamic range-of-motion testing to your regimen. You and your patients will be impressed with the results.
Dr. John Wohar graduated Summa Cum Laude from Palmer College of Chiropractic in Davenport, Iowa in 1981. He and his wife, Linda, are the proud parents of 10 children and 20 grandchildren. He maintains a successful practice from his home office in California, Pennsylvania, where he continues to work on his Viscero-Somatic Reflex Technique. He can be contacted at [email protected].
