I began my college career as a music major at Eastern Kentucky University. It was a great deal of fun, and I met several of the most interesting people I have ever known. One of these individuals was the professor of percussion, Dr. Donald Cooper.When he walked into a room, everyone took notice. He had a striking appearance. He wore dark suits, was always tan, and his hair and goatee were silver. Everything he did was smooth; walk, talk, play the drums and even smoke (which was still considered smooth in those days). It was the '80s, but if it had been the '60s he probably would have been described as"Cool Man Cool."
Dr. Cooper had played with some of the biggest names in the music business. He once took me to a Percussive Arts Society convention in Indianapolis; many of the most famous drummers in the world came over and said, "Hey Don, how've ya been?" I spent the weekend with him and many of my other heroes. At the age of 18, that's a "wow!"
In addition to music, Dr. Cooper loved to fly his plane and play golf. In fact, he passed away doing one of the things he loved - he suffered a heart attack in the middle of a round of golf.
As my teacher for private lessons, he liked to have me play music sight unseen or sustain a drum roll while he recorded it on an old reel-to-reel tape machine. He always played the recording back at a really slow speed. No matter how well I thought the music or the roll sounded at normal speed, it sounded terrible slowed down to the individual stroke. The goal was to make every stroke sound the same.
The challenges were fun during the lessons, but less fun in real-life situations. Dr. Cooper provided one of those real-life situations during my second music jury. A jury was a panel of three music professors; the one who taught your private lesson and two others. To receive your final grade for the lesson class, you had to perform for the panel. The professors critiqued your performance and could ask questions about the music you had played in that performance or any anything else you had played during the semester.
I played a four-mallet marimba arrangement and a snare drum piece. During the snare piece, the three professors left their positions behind the table and stood behind me. They watched and listened as I played. It went well and I was glad when it was over - at least I thought it was over.
The panel commended my performance and then Dr. Cooper said, "Now comes the fun part". He took the music off the stand, turned it upside down and said, "Now play it upside down from the end backwards."
I am sure I looked at him as though he were kidding. The other professors began to laugh, but Dr. Cooper was serious. I knew from his sadistic grin that he was not kidding. I looked at the music and realized I had to reverse all of the rhythms; I took a deep breath and started playing. I played the first line without missing a note. He then stopped me and told me I had passed the test.
It may seem like a minor challenge in life, but I have thought about that day frequently over the years. I have thought about the stress of the situation, pulling the rabbit out of the hat and the confidence Dr. Cooper had in me to do what he asked. He helped me have confidence in myself. It was a wonderful lesson from a wonderful teacher.
So, what does this have to do with chiropractic? Throughout chiropractic college we were bombarded with the principle "above down inside out." It is a principle we have lived by. However, practice has showed me it cannot cover every situation I encounter. There are other principles that must be considered in providing appropriate patient care.
One of these principles (actually it's a law of nature) is gravity. Gravity works from the feet up. Another principle is that information is received from the periphery of the body and moves from the periphery inward and up. Proprioception is an example. These principles were discussed in chiropractic college, but not to the degree that "above down inside out" was.
Some chiropractic spinal techniques do note the contribution of the lower extremities to spinal conditions. Gonstead technique and Barge's tortipelvis and scoliosis techniques advocate heel lifts under certain circumstances. Their recommendation are based, however, on line drawings of lumbopelvic X-rays. Analysis to determine the lower extremities' contribution to pelvic obliquity is secondary. Only select segments of the kinetic chain are looked at in these methods.
When considering above down inside out, gravity, proprioception and the kinetic chain, how is it possible to look at one without looking at the other? Shouldn't a doctor be able to work through the diagnostic and treatment processes from either end, knowing them forward and backwards? If the doctor does not consider each of these, is it the best possible situation for the patient?
Ultimately, these questions are answered by the doctor's choice in style of practice. Some choose to provide treatment for only the body regions that are symptomatic, while others provide a whole-body approach. The whole-body approach requires that the doctor take the four factors discussed above and others into consideration for examination and treatment.
Are you considering every aspect of the patient in your evaluation and treatment? Should you reconsider your approach to patient care? If you're not already doing it, I recommend trying examination and treatment upside down from the end backwards (starting from the ground up) for a change. You will be surprised at the benefits your patients will experience and the increased satisfaction you will feel as a doctor.
Click here for more information about K. Jeffrey Miller, DC, MBA.