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For more information about chiropractic treatment, contact:


M. Todd Staker, DC
Ben Schemmel, DC
Trevor Williams, DC

3550 NW Cary Parkway, #104
Cary, NC 27513
Telephone: (919) 460-1515

Symptoms Are Often Misleading

Understanding the musculoskeletal system may be where chiropractic care begins, but it is far from defining the full range of this holistic and integrative discipline.

Dr. Todd Staker, of Staker Chiropractic Center in Cary, and his two colleagues, Dr. Ben Schemmel and Dr. Trevor Williams, in a lively conversation explain how complex the chiropractic process can be when it comes to teasing out the cause of a patient’s pain and developing an effective treatment plan.

Dr. Schemmel (left) and Dr. Williams utilize a new, sophisticated X-ray system as a principal diagnostic tool.

“Symptoms are often misleading,” Dr. Staker says, “which in itself is interesting and challenging because symptoms are generally the first point from which we begin to figure out what’s going on with a patient in pain. Because they are sometimes misleading, we need to look at a patient’s symptoms as a starting point in developing an effective treatment plan. Our job is to determine how the whole body and all of its systems are functioning, individually and in relation to one another, and where there are systemic problems that need to be addressed.

“A main tenant of chiropractic care,” continues Dr. Staker, “is the understanding that the health and function of one body system affects the health and function of another. If someone presents with knee pain, it isn’t adequate to only treat the knee, because while significant pain may be coming from the knee, the origin of that pain may actually be in the hip, for example.”

Nerve-related problems, notes Dr. Staker, “are probably our most challenging diagnostic issue for this reason, because a single nerve traverses a large area of the body. Carpal tunnel syndrome is a common complaint without a single cause. So we have to discern if the pain is stemming from an issue in the neck, the forearm, or is it a problem coming out of the trap or brachial plexus. And it could also be a cervical disc problem. There are many possibilities. Determining the actual cause of the problem, and moving on to treat the correct cause, can be a challenge.”

The Diagnostic Process

Health&Healing: If symptoms are often misleading, what exactly is a chiropractor’s diagnostic process?

DR. WILLIAMS:  The process really starts with the patient’s story. The very first step is just to listen. With something severe, like acute back or neck pain, about half of the time the person knows what triggered the pain, and half the time they don’t. When they can tell me exactly what they were doing when an injury occurred, that of course makes the whole process easier.”

H&H: And when they can’t?

DR. WILLIAMS: Then we get into a deeper line of questioning. Often, when the answer isn’t readily presenting itself with some basic assessment, something relevant to what’s going on has been completely overlooked by the patient. For example, someone comes in with mid-back pain. They haven’t been lifting anything, twisting, or starting a new exercise. Then as we’re talking about their general health, they’ll say, “Well I’m having some difficulty urinating,” or “there’s been a little bit of blood in my urine.” They have no idea that this information is important during a chiropractic visit for back pain, but it changes the whole line of thinking.

As Dr. Staker mentioned, the whole picture of health is very important. Now, instead of musculoskeletal pain, I’m considering a possible kidney infection, for which he needs assessment from his primary care provider.”

H&H: What would you say is one of the most challenging diagnostic processes?

DR. WILLIAMS: Headaches. Headaches are a common problem with so many possible causes. And there are so many categories of headache: hormonal, cyclical, stress or food allergies, headaches stemming from the spine, neck, or jaw, visual disturbances, true migraines, etc.  For example, a patient recently came in with chronic migraines, and had tried just about everything to figure out a cause of the problem. She had done food diaries trying to identify a food-related trigger, hormone replacement therapy searching for a hormonal cause, relaxation, Botox injections—the list went on. She also had stopped exercising, which was something she loved, because her headaches were worse with exercise.

Ultimately, we determined that the problem was her sub-occipital nerve, which was entrapped in some soft tissues, just beneath the skull. This was something I was able to release with the Active Release Technique and restored the motion to that first vertebra in her spine. But I was only able to do that once it was identified as the problem, and it was a long and tedious process to get there.

H&H: What diagnostic assessments and tools are the most beneficial when trying to identify a presenting complaint?

DR. SCHEMMEL: The primary assessment and diagnostic tool for any chiropractor is—or should be—their own hands. Palpation, the act of using one’s hands to assess a physical problem, is a simple place to start, and it is at the same time our most important technique, acquired skill, and diagnostic tool.

H&H: What can palpation tell you right away about what’s going on with a patient?

DR. SCHEMMEL: So much. By putting my hands on someone I can identify areas of tenderness, lack of motion, improper motion, fixation, inflammation, soft tissue tension, or misalignment. Then, from there we can use X-ray and CT scans to help further the diagnostic process or confirm a suspicion.

And sometimes, when you’re working with the human body, the diagnostic approach is just a hunch. I once had a man come in with slight back pain, so immediately I’m thinking muscle strain or sprain. I didn’t find any obvious cause, but made a few adjustments and he felt better. Then he came back a few days later with the same pain, and I told him “I don’t know why but I just have a hunch this is shingles.” And sure enough, it was shingles.

H&H: When you have a hunch like that, about shingles, or a kidney infection as Dr. Williams mentioned earlier, is the next step a referral?

DR. STAKER: We have a network of physician colleagues, such as neurologists and neurosurgeons, with whom we work closely. If the three of us do not see the changes we are trying and expect to achieve with a patient, or if we just cannot seem to come up with a good resolution of the presenting problem, we’re not going to drag the process on for months with chiropractic treatments that aren’t helping. We are going to refer to a different type of physician that we think may be able to help in ways that we couldn’t. That’s one of the things we do well in our practice: we draw a line. When a patient isn’t improving in two or three weeks, that’s the line.