This is not dissimilar to the way I need to evaluate a patient. Age, sex, family history, occupation, diet, physical activity, injuries, illnesses, and many other factors need to be probed. Depending on the answer given to a particular question, it leads to the next question that needs to be asked. The examination is then formulated from what has been gleaned from the history and consultation. Each positive or negative finding leads to the test that should follow.
Over the years of evaluating many, many patients, I have developed algorithms that run through my mind to help me quickly and accurately assess what is going on. An algorithm is defined as a formula or set of steps for solving a particular problem. To be an algorithm, a set of rules must be unambiguous and have a clear stopping point. For example you can have an algorithm for baking a cake. It might look like this:
Evaluating a patient is certainly more complex than baking a cake and instead of a simple algorithm, algorithms often need to be combined to get valid results. If a patient has just one simple complaint, say a sprained ankle, there are few steps necessary to make the diagnosis and develop an approach for rehabilitation. Few people present with such a simple situation. Although a person may have one complaint, perhaps low back pain, there can be many factors which lead to the condition and usually involve more than just the lower area of the spinal column. By having a logical sequence to follow, an algorithm, clues don't get missed and the best possible conclusions can be determined. During both the history and examination of a patient with low back pain, algorithms for evaluating the lumbar spine, pelvis, and hips will likely be combined. The knees, feet, and even the neck may be added depending on what is revealed.
Activator Methods, my primary chiropractic technique, is based on a series of algorithms that allows for very efficient and thorough evaluation and adjustment of the spine and extremities. The Activator Methods basic scan for the lumbar spine looks like this:
This basic algorithm covers most low back conditions. Should a patient present with a more complicated situation there are advanced algorithms that can be applied to evaluate the lumbar spine more thoroughly. Following the algorithms leads to effective care of low back conditions. There is less likelihood of missing pieces to the low back pain puzzle.
Whether I'm work with a new patient or during a routine office visit, I have algorithms constantly going through my mind. As a result I can quick evaluate the spine and extremities for subluxations and determine the best chiropractic adjustments for a given patient. By putting the pieces together I know where, when, and when not to adjust. This is crucial to being an effective chiropractor.
