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A Hair Under the Paper
When I was in chiropractic college, we were encouraged to practice finding a single human hair under a sheet of paper. When that became easy, we were to try two sheets, then three sheets, and so on. The idea of this exercise was to sharpen our sense of touch to enhance our ability to assess our patients.
An examiner’s use of the sense of touch to gain clinical information is called palpation. In chiropractic palpation, the examiner is usually searching for significant asymmetries. For example, is there a left-right difference in the tension of the muscle tissue next to a vertebra? Can the chiropractor sense a vertebra resisting movement in a particular direction? Does the skin temperature near the vertebra tell the examiner something of significance?
While different chiropractors use different combinations of assessment techniques, most practitioners incorporate some form of palpation to determine which vertebra to adjust at any particular visit.
Muscle: The Circuitry and the Machine
Certain muscles are extremely helpful in chiropractic examination because they are controlled by a particular spinal nerve. There are several ways to test muscle function. The simplest and probably most common is to test the ability of the patient to hold a position against the examiner’s force. For example, the doctor may ask you to bend your elbow. Then she or he will ask you to resist as they try to straighten it. This tests the biceps muscle in the arm. If your ability to control your biceps on one or both sides is significantly impaired, that would cause the chiropractor to suspect a mid-cervical problem. This is of course assuming there was no apparent injury in the elbow itself.
While practices differ in their approach, some form of muscle testing is commonly incorporated into the assessment of the patient.
The Sensory Mosaic
Your skin is loaded with nerve endings that allow you to perceive light touch, deep pressure, heat, cold, and vibration. An area of skin in which these nerve endings are connected to one particular spinal nerve is called a dermatome. A map of the dermatomes resembles a mosaic. (See dermatome map.) Dermatome testing can give a chiropractor information about which vertebral level is distressed. For example, if the patient is able to feel a small brush moving lightly over the left thumb, but unable to feel it clearly over the right thumb, the examiner would suspect a problem involving the sixth cervical (neck) vertebra. If the vibration of a tuning fork could be clearly felt on the left small toe, but not the right, the examiner would suspect a problem in the lowest lumbar (low back) vertebra or the sacrum (in the pelvis).
Dermatome testing is sometimes used in the initial examination of a patient, to help establish a baseline so that the outcome of care can be tracked.
It’s Not Just About Where It Hurts
Needless to say, the chiropractor’s job would be easy if they could simply thrust on the place you point to when you say, “It hurts right here, Doc.” In reality, an examiner can never assume the location of a pain is the location of its cause. Pain can be deceptive and vague. Pain can appear distantly from its cause – a phenomenon known as referred pain. Spinal nerve irritation can be painless, causing numbness, muscle coordination problems, balance difficulty, and other manifestations.
As a result, chiropractors use a wide variety of assessment techniques. Some of these are the hands-on procedures discussed here. Others use various instruments and technologies. While the techniques vary, the purpose is the same: to locate correctible disturbances in the joints – especially the spinal joints – that are causing nerve interference. Chiropractic adjustments are then administered to assist your nervous system in re-establishing wellness.
Source For This Article
Whitman PA, Adigun OO. Anatomy, Skin, Dermatomes. National Library of Medicine, September 12, 2022. https://www.ncbi.nlm.nih.gov/books/NBK535401/
About the Author
While serving as a medical specialist (MOS 91-B) in the U.S. Army Reserve, Dr. Masarsky earned his Doctor of Chiropractic degree from New York Chiropractic College (now Northeast College of Health Sciences) in 1981. He is in the private practice of chiropractic in the Virginia suburbs of Washington DC with his wife and partner, Dr. Marion Todres-Masarsky. For further information or appointments, contact Dr. Masarsky at 703-938-6441 or viennachiropractic@verizon.net. His practice’s newsletters, doctors’ biographies, published clinical papers, and You Tube channel can be accessed at this website: www.viennachiropractic.com.
