Chiropractic + Naturopathic Doctor

Features Clinical Patient Care
Kids First, Part 2


July 14, 2009
By Ogi Ressel DC

Topics

Have the child stand in front of you with her back to you – you are
right behind her. Make certain her mom is behind you so that she can
see what you see – this is crucial! In front of the child, mounted on
the wall and in the line of sight of mom, should be the postural chart
entitled “Would Your Child Pass This Test.”


From Part 1: OK . . . . You are ready to begin. The cute seven-year-old is standing on the floor, in her gown, and her mother and she are waiting for your direction. Here we go . . .

Have the child stand in front of you with her back to you – you are right behind her. Make certain her mom is behind you so that she can see what you see – this is crucial! In front of the child, mounted on the wall and in the line of sight of mom, should be the postural chart entitled “Would Your Child Pass This Test.” It shows mom postural changes she may see in her child, and assigns them a numerical value. If the total scores are added up and are over five, it indicates that there may be a problem – this is a great way of imparting reality.

DO YOU SEE WHAT I SEE?
Be able to demonstrate any obvious postural deviations this child may have: low shoulder, low ear, high hip, obvious curvature, knee extension, erector spinae spasm, etc. It is important that mom can see what you see. What is most important, however, is that she is in agreement!

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If she is not able to see what you see, then stop and make certain she has an opportunity to catch up with you. This can be tricky at times; many patients will not want to appear “stupid”, so they may agree with you when asked if they see what you are pointing out. They may nod their head, etc., indicating that they understand, when in fact, they don’t. In the meantime, you tend to babble on and then wonder why these patients have decided not to start care with you. This is a common mistake. It is easy to get caught up in hearing yourself speak.

The main thing here is to have mom in agreement so that what you are speaking of is real to her and her daughter. If there is no reality, and no agreement, these patients will not be starting care. Period.

A COMMON FINDING IN CHILDREN

Let’s go back to your exam of this seven-year-old child.

You are kneeling down with your little patient in front of you, and mom is sitting on a stool, looking over your shoulder.

Place your hands on the girl’s pelvis so that your thumbs are on each posterior superior iliac spine (PSIS). Ask your little patient to hang onto a doorknob, your wrists, a table, etc., for support and then ask her to raise her right leg, flexing her right knee. Notice and compare the movement of the right PSIS (your right thumb) to your left as her knee is raised – it should descend. Repeat the same procedure on the left – your left thumb should also descend. This is normal.

But, wait a moment! When your patient raised her left leg, your left thumb, which you fully expected to descend just like the right, actually ascended.

Explain to mom that the pelvis functions much like a gyroscope – there are opposing and counterbalanced forces at work, and each side of the pelvis should function equally at 50/50. This is normal.

Show her a repeat performance of what you just saw and explain what youare finding – that the right side of her daughter’s pelvis is functioningovertime (hypermobile) while the left side is not working enough (hypomobile). There is unbalance and inequality. She will totally understand. Why? Because she can see it. It is real.

Explain that this is most likely the reason why her daughter is beginning to develop the spinal curvature you may have found, or her poor posture, symptoms of knee pains, etc., that she may be experiencing.

If you noticed all that, I want to congratulate you. You have discovered what we have called the Pelvic Distortion Subluxation Complex (PDSC). This entity affects many children and its effects are widespread.

What you’ll find is that 96 per cent of all children will have a fixation subluxation of the left pelvis and a corresponding hypermobility of the right. The remaining four per cent will have a fixation of both sides, or a fixation of the right – but these are rare.1

FURTHER THINGS TO CHECK
OK . . .you have just pointed out, to mom, a problem with her child. Tread easy from now on, as you are creating a new awareness. As well, your little patient may feel a bit of anxiety, at this point, most of it the result of reading her mom. This is common. Relax. Explain that you’ll give answers as your examination unfolds.

Have your young patient sit on your exam bench and have a good look at herhead and her face. Check out the level of her eyes, eyebrows, cheek bones, ear levels, and forehead, etc. As well, look for asymmetry in her face in general – nose symmetry, lips, and chin. Also have a look at this patient’s head symmetry from above, looking down – make certain that mom sees what you see. You are looking for possible effects of traumatic birth syndrome (TBS).

Check the function of both tempero-mandibular joints (TMJ) and compare one side to the other – have the little girl open and close her mouth and look for symmetry of function. Palpate both and determine if one side or the other is either hypo- or hypermobile – the hypermobile side will be tender to touch, the hypomobile side will palpate as spastic.

Measure each of her head hemispheres with a tape measure – starting from the external occipital protuberance to the nasium. Both measurements should be equal.

Findings, during this part of the exam, are important, as asymmetry in any of these areas may point to TBS. Be able to show mom what you are finding and explain briefly your suspicions. It is important that you make total sense to mom, and that all you are saying is logical to her.

Let me assure you – you have mom’s complete attention at this point.

GETTING MOM INVOLVED

The cute seven-year-old is now sitting on your exam table as you stand behind her and palpate the function of her cervical spine. Make certain you talk here. Mom needs to know how this whole thing works – so talk! This is not the time to be quiet! But don’t talk about the weather, or sports, or the wonderful weekend you have had. Talk to mom about her daughter!

Have mom stand in front of her daughter and have her place her hands on her daughter’s neck. Place your hands over hers and palpate through her fingers – it is important mom feels what you feel. This gives your examination a sense of reality. Think about this for a moment: how do you explain what you mean when you say that this child in front of you has a subluxation. What exactly does that mean to the average parent? Do they fully understand it? Or do many parents simply agree with you because they do not want to appear “stupid”?

Make certain mom feels what you feel and is in agreement with you.

MORE AREAS TO EXAMINE
Next, have this cute munchkin hold onto her shoulders as you motion-palpate her thoracic area. Make certain mom can see and feel what you are finding – that is the key. Remember, we are working with establishing reality here.

Have the child lie down on her back. Remind mom that the right side of her daughter’s pelvis is working “overtime” and the left side is not working enough. (Remember?)

You may notice that the muscles of the tensor fascia lata (TFL), or the illiotibial band, will be hypertonic on the side of hypermobility – usually the right side.

This is a protective mechanism in order to limit the movement of the right illium. At the same time though, the TFL will cause a subluxation of the right tib-fib articulation and a reflex spasm of the muscles of the anterior compartment of the lower leg. Again, make certain that mom can feel what you feel and compares this to the left side, which should be nice and relaxed.

The right medial aspect of the deltoid ligament at the ankle may also be taut and will be very painful on light palpation – mom should agree with you.

If there are findings in many of these areas, you are seeing the results of the PDSC, a series of cascade events which can slowly erode the health expression of the child in front of you. Your mission is to wipe out this erroneous programming.

Palpate the costo-sternal junction and in cases of early spinal curvatures,you’ll find this area very tender to touch – one of the first indicators of the beginnings of scoliosis.

Have the little girl turn over onto her stomach and do the Deerfield leg check. Have mom see what you see and have her agree with your findings, if you have any. Again, mom’s agreement is crucial.

Palpate the child’s spine and tell mom what you are finding. It is important to relate what you find to the child’s complaints, if any.

Your examination is now complete and you are now ready to perform scans.

Parents need to see proof of what you are finding and how it is impacting their child’s health. The explanation is simple: “I’m checking to see how her nervous system is controlling her internal functions.” Most parents are totally OK with that explanation – it’s simple.•

References:

  1. Ressel, O. Vertebral Subluxation Correlated with Somatic, Visceral, and Immune Complaints: An Analysis of 650 Children under Chiropractic Care. Journal of Vertebral Subluxation Research. October 2004. www.jvsr.com .

Dr. Ogi, as he is known by most, is a prolific writer. He initiated the Pediatrics course at CMCC and taught for the ICPA, has written two books on chiropractic and children’s  health issues, has published a number of research papers on kids and was a staff writer for two national magazines. He stopped active practice in 2003 when he realized that he could reach many more children, and their parents, by teaching other DCs how to treat kids – check out his Practice Evolution Program: www.practiceevolution.com .


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