Bates Physical Examination and History Taking is the kind of book that makes the examination of the eyes, in for example the patient with potentially a cerebral aneurism, the lymphatics, the abdoman and the axilla and groin routine and plausible in the chiropractic practice.
Every chiropractor is faced with patients with a potentially medical diagnosis on a daily basis. Today it was a lady with shoulder pain of some months duration; it was resisting various treatments including another chiropractor's needles. Just a few questions revealed extreme fatigue, and black blood in the stool. Was she taking anti inflammatory drugs?
Yes, she had recently been for a gastroscope for abdominal pain, confirming duodenal ulcers. She was shocked to hear that she could bleed death internally; 14,000 Americans do precisely that every year. It's called iatrogenic disease.
Does it pertain only to medical doctors? Alas no, I had a patient today who two days after a routine maintenance care treatment developed very severe lower back pain. Was my chiropractic treatment responsible? Perhaps so.
And then a patient with severe facial pain; she had been diagnosed with trigeminal neuralgia. But I had my doubts; swelling under the eye suggested that this was an infected sinus. But there was distinct sensory change in the distribution of the trigeminal nerve. Was a thorough Bates physical examination and history taking necessary?
The deep pelvic muscles play a vital role in a healthy pelvis. Together with the Oblique abdominal muscles and the small muscles that run between individual vertebrae in the lumbar spine, the deep pelvic muscles make up a "pelvic corset" that supports the spine when bending, twisting and lifting.
In addition, these deep core muscles play a vital role in supporting the bladder, in pregnancy, in childbirth, and in fact during intercourse.
The Kegel exercises are simple, quick to do, and should be done by every person, and in particular women, every single day. A small discpline, like brushing teeth, will prove a worthy investment of 30-60 seconds per day in times to come.
The setting out of tables in this book is particularly neat and effective. For example, many patients in the chiropractic practice complain of Constipation.
Table 2-9 gives a full outline of the problems, all relevant to the chiropractor treating the constipated patient, taking one far beyond constipation caused by dietary inadequacy and subluxations.
Likewise photographs and diagrams are outstanding.
The lower limb causes untold misery for many and BATES's book makes for an excellent start. Of course as Chiropractors, with out motion palpation skills we are able to take it a step further.
But true to Bates, everything begins with a good history and regional physical examination.
The management of headache needs to be thorough and careful as every
doctor of every ilk knows. The medical doctor needs to be sure that the
underlying cause of the migraine headache does not lie in the cervical
spine or TMJ and is thus very treatable; likewise the chiropractor needs
to be sure that this isn't meningitis, or a brain tumour; referral
between medicine and chiropractic is vital in the management of the
patient with headaches.
Bates physical examination and history taking has an excellent section on musculoskeletal pain, yet I was disappointed in the examination of the patient with hip pain.
Not a day passes when the average chiropractor is faced with complex hip, groin and buttock pain. Is it an SIJ syndrome, or could it perhaps be hip dysplasia? What about a piriformis syndrome, or perhaps femoro acetabular impingement syndrome?
Access to quality medical diagnostic books greatly enriches the understanding of the chiropractor who perhaps like me, had his training in the last millennium and such things were not discussed or taught. In fact the diagnosis of FAIS was only constituted in the last twenty years. Do you have a young patient, doctor, with a very stiff hip; if he was sixty you would categorically state that he has hip arthritis.
But he's a young man. How can a twenty year old have hip arthritis? He hasn't but he may well have an impingement syndrome, either a pincer or CAM deformity.
There's heaps of evidence that bodies in motion suffer from less pain and less arthritis. I advocate that every single person should be doing these
LOWER BACK EXERCISES whether you are suffering from LBP or not; just as we brush our teeth, regardless of whether we have the pain of caries or gum disease or not.
Many insurance companies now only pay for physical therapists to provide a chiropractic adjustment; that's in the face of powerful research proving that inclusion of DCs to perform their own technique would save them a good deal of money. One has to conclude that political medicine has gone off on another tack to contain our profession.
It's being successful with some doctors of chiropractic quitting. Others become involved in some dodgy practices, like demanding that patients sign up for a whole year of treatment in advance, in order to stay in business.
In recessionary times, the going is tough when the insurance won't pay.
Is the day approaching for a new Wilk versus the AMA and the insurance companies?
The chiropractic profession has tried hard to stay on the moral high ground; those who stoop to unscrupulous practices need to be exposed and disciplined if we are not to stoop to the low blows that medicine has often resorted to contain and eliminate us.
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