The Chiropractic Assessment
The Chiropractic assessment, Chiropractic examination, nerve function, muscle testing, reflexes, when chiropractors refer on, and more...
Chiropractors carry out extensive evaluations to assess whether a patient is a candidate for chiropractic care. During evaluations a thorough history is taken which includes directed questions covering everything from past illnesses, previous scans, medications and treatments to current presenting symptoms.
A thorough health history helps build a case and differential diagnosis to link in with the physical examination. Following is a simplified overview of some of the key components that you should expect a chiropractor to include in an assessment, history and physical examination on initial consultation.
Chiropractors go through a thorough neurological evaluation to rule out or in any abnormal findings from the norm. Sometimes chiropractors can detect upper motor neuron lesions that need medical evaluation and referral and cannot be treated by a chiropractor.
Early incidental detection for some patients with “non-chiropractic” problems has helped them access appropriate medical care. Among other findings, there are many anecdotal cases where as a result of a chiropractor detecting abnormal findings in an assessment a patient has been directed to specialist care through their GP.
The chiropractic assessment - The neurological examination
Every chiropractor should assess nerve function which includes:
- Deep tendon reflexes : A reflex hammer is used to test “knee jerk”, “ankle jerk”, “biceps femoris”, “elbow jerk”.
What’s a normal deep tendon reflex?
It’s normal for some of us to actually have no noticeable reflexes when both sides are bilaterally the same. Other factors may also be taken into account and other parts of the physical exam are also focused on to rule out neurological complications. Generally however it’s abnormal to have excessively brisk reflexes especially if both sides of the body are different and especially if it’s accompanied by clonus. In these cases, immediate specialist medical referral or help is required.
Fast reflexes, abnormal deep tendon reflexes- what do they mean?
Fast / rapid reflexes can be attributable to drugs, or upper motor neuron lesions in the spinal cord and brain. Brisk reflexes with “clonus” usually indicate the connections within the spinal cord and brain possibly have a lesion. An example of a disease with brisk tendon reflexes Includes Multiple Sclerosis (MS), stroke and encephalopathy (pressure on the brain from swelling).
Slow reflexes what do they mean?
Slow reflexes, especially when compared to a normal (opposite side of the body) reflex, usually means there is likely a lower motor neuron lesion present (LMNL), examples include disc disease, sciatica, peripheral nerve involvement.
Testing for “clonus”
Clonus indicates an Upper motor neuron lesion (UMNL) / disease and is seen at the end of a deep tendon reflex, characterised by a rapid series of large involuntary muscle contractions and relaxations. The best way to test for clonus is by dorsi-flexing the ankle (extending it back and holding it there).
What other areas of the spinal cord / nerves do chiropractors test?
Dermatomes are areas mapped out by peripheral nerves, subjective (patient) responses to selected stimuli such as sharp, soft, vibration and temperature are tested. These tests all correlate to nerves and fiber tracts from external stimuli.
Sensation testing is done with a tooth pick or pin wheel to test responses to “sharp” stimuli, a soft cotton bud tests stimulatory response to soft touch. A tuning fork tests the posterior columns for vibration and a warm heat pack tests response to temperature for the spinothalamic tract.
Muscle strength testing for the upper and lower limbs
Muscle tone and strength is tested in the upper and lower limbs, this also links in with other parts of the physical examination to build a working diagnosis.
What is a pathological reflex?
Abnormal response to a specific stimuli
Pathological reflex- Absent or present
A pathological reflex also helps decipeher whether there is an upper motor neuron lesion (UMNL) in the corticospinal tracts of the brain.
Commonly a pathologic reflex tested is called the “Babinski reflex” where the base of the foot is stroked from the heel along the lateral sole of the foot towards the big toe. A positive “Babinski” reflex is characterized by flaring of the toes and extension of the big toe (except for young babies). A positive babinski reflex is an ominous sign and requires further medical evaluation including MRI, CT and other tests.
What are the signs that a chiropractor looks for if they can’t provide treatment?
Chiropractors help patients with detected abnormal neurological findings to seek proper medial help and evaluation. Chiropractors are focus their profession on the assessment, diagnosis and treatment of musculoskeletal dysfunction. Among incidental findings that chiropractors do not provide treatment for include:
Upper motor neuron lesions signified by brisk tendon reflexes, present babinski (pathologic reflexes), clonus and sciatica among other related disorders.
There are other parts to the physical exam including chiropractic orthopedic testing for related parts of the body, joint ranges of motion and joint motion palpation which can also be found in the website. Always contact a professional GP or medical centre if you suspect you have anything other than general muscle stiffness and joint tightness that could be treated by a chiropractor.