The importance of a head-to-toe assessment in chiropractic
My pain is in my shoulder so why are they looking at my hip? – Have you ever had a thought like this during a consultation? Well, Dr Igor is here to help explain the importance of a head-to-toe assessment.
When a patient arrives to a chiropractic clinic they are often unsure about what to expect from the initial examination as well as future treatment. At times the main area of concern can be well localised which leaves patients confused why the whole body needs to be assessed and treatment often performed on a different area, not the one where the patient says the pain originates from. This can be confusing and frustrating for the patient but there is a scientific, yet complex, explanation for this approach. Let’s try to break it down to a meaningful explanation.
A thorough physical examination helps to identify any underlying health concerns regardless of whether a patient experiences symptoms or not. Think of having a blood test, or a blood pressure reading to assess for a risk of stroke. It helps to assess which areas of health and body require attention so they don’t cause an issue later on. When pain and/or dysfunction affects activities of daily life and is well localised by a patient, the assessment aims to identify whether the area of pain is actually the area that requires a specific treatment. It is not uncommon for a patient to experience referred pain from the neck down the arm (radiculopathy) or lower back down the foot as in a case of sciatica, although, some patients present with leg pain and no lower back pain. In other patients’ pain from the lower spine refers down the leg and stops at a knee level which may require a different treatment approach, as it may be referred pain from the joint rather than a nerve related issue. Does this sound confusing?
In order to understand what structures are affected and likely to cause pain a thorough investigation is required. In addition, a biopsychosocial questionnaire is conducted in order to understand biological, psychological and social aspects of a patients’ life and its dynamic interaction. These vary from individual to individual and require a good rapport between a patient and clinician in order get to the core of a patient’s concern and find an appropriate management plan.
It is not uncommon for a chiropractor to examine patients’ posture and walking – even if these do not cause pain – in order to assess the biomechanics and gait. Multiple clinical studies showed that abnormalities in structure of the foot and knee are linked to the development of excessive stress and pain above, for example hip joint or even spine as well as associated muscles. The symptoms are not always obvious and sometimes only noticed by patients’ relatives or friends and described as: ‘funny walking, ‘your shoe is getting worn down on one side’ or ‘you trousers are longer on the other side’. These are some of the examples that suggest altered alignment with uneven overuse, changes in gait cycle and increased muscle strain. The body is amazing in various ways, specifically in its ability to adapt and adjust for many years without causing pain and/or significant limitations. By the time a patient comes to the clinic with pain or concern, the body has often fully adapted to a certain position with significant muscle imbalance that might require a chiropractic detective job in order to establish what is primary or secondary, and what and where requires treatment.
It helps to look at the body as a complex and interconnected system. Instead of thinking of a biceps muscle or a knee joint as single units we must appreciate the connection between various muscles, joints and various systems that provide efficient governance and control. It is therefore a combination of knowledge, thorough analysis, experience and art that allows a clinician to assess, diagnose, and help the patient to return to their favourite activity, work and optimal health pain-free.
Appreciating the complexity of the human body and necessity for a head-to-toe assessment helps to set expectations, avoids misunderstanding in communication and errors in diagnosis, contributes to prevention, and helps patients’ to achieve their heath goals. We hope this helps you understand why a chiropractor might check your feet and toes and assesses your leg strength when your primary concern is back pain or shoulder pain. They don’t do it out of curiosity but to get to the root of the issue.
To get started on getting to the root of the issue, get booked in today.
