Dysponesis, dyskinesia, dysautonomia: These are three big words that are the heart and soul of chiropractic examinations and professional care. They encompass most of the measurable dysfunction we are capable of affecting and when improved, account for the health benefits we have been lauded for these past one hundred and five years.
Dysponesis is defined as a reversible physiological state consisting of unnoticed, misdirected neurophysical reactions to various agents (environmental events, bodily sensations, emotions, and thoughts) and the repercussions of these reactions throughout the organism. These errors in energy expenditure that are capable of producing functional disorders consist mainly of covert errors in action, potential output from the motor and premotor areas of the cortex, and consequences of that output.
Our professional care should involve understanding the state of mind of our patients, and how that state of mind will affect their responses to our care. The best way I know of is to then ask patients how they feel about their symptoms and record their answer. You may get all kinds of reactions to such a question, ranging from anger and hostility to emotional outbursts. All are probably more expressive than the words used. They will tell you the state of mind the patient is in, and should be on record.
Dyskinesia is defined as "dysfunction in muscle physiology." This dysfunction can be measured in a number of ways:
- Traditionally we have used the x-ray to observe misaligned vertebra and have reasoned that in order for a vertebra to be found in misalignment, a muscle attached to that vertebra must have contracted, and remained in that contracted position because of an injury to the opponent muscle. Ligament and disc damage also are well documented on x-ray, and these add another additional factor.
- Uneven muscle contractions also may be palpated. A contracted muscle will have a "sore-to-the-touch" tendon. This measurement has been used since the beginning of chiropractic in 1895.
- A contracted muscle will have an opponent muscle that will test weak. Reflex muscle weakness has also been observed in many of the large muscles of the body directly connected to this direction of weakness. (For example: a contracted psoas muscle would indicate a weak gluteal or hamstring muscle and could be associated with any vertebra in a flexed contraction. Testing the strength of the leg and arm muscles can yield information about the position of the contraction.)
- Motion palpation of the vertebra of the spine can also be an aid in determining the position of the muscle which has been damaged since the vertebra above the damaged muscle will not move as well against the contraction as it moves in other directions; reflexly, neither will the vertebrae above the damaged one. This reluctance in motion surely must respond to our care.
- Breath motion between vertebrae is another way to assess muscle function. When a goniometer is used, (one prong on one vertebra and the other prong on an adjacent vetebra,) there should be six millimeters of movement between the prongs. If six millimeters of movement are not found, contraction of muscles between these vertebrae can be reasoned. Reflex contractions also exist in many of the large muscles and may be ascertained. The 45mm of goniometer movement between illium and scapulae is one example.
- Derefield short-leg measurement is another manifestation of reflex muscle imbalance.
- Use of surface electromyography has also extended our knowledge of muscle imbalance. Contracted muscles are indicated with increased microvolt readings, and opponent weak muscles are indicated with decreased microvolt readings.
Dysautonomia is defined as "alteration of bodily functions from standards which should not be noticed." Symptoms of this include: pulse rate; blood pressure or temperature that are too high or too low; bowel dysfunction; indigestion; allergies; menstrual dysfunction; headaches; and high respiratory rates. All of these things indicate that the body is not in highly tuned communication through the nervous system.
All three of these manifestations of dysfunction need to be addressed with each patient we see on each visit.
William D. Shepherd,DC
Oshkosh, Wisconsin
