HIPPRONIL - A Chiropractic Mnemonic
A Diagnosing Tool
HIPPRONIL is a mnemonic tool used to begin the process of diagnosing. HIPPRONIL stands for: History, Inspection, Palpation, Percussion, Range-of-Motion, Orthopedic, Neural, Imaging and Lab.
Chiropractic care focuses on the NMS, neuromusculoskeletal, or neural-muscular-skeletal systems of the body. Drugs and pharmaceuticals are out of scope of practice for chiro care; however, nutrition and supplements are well within the scope of practice.
“Chiro” is Greek meaning hands. Chiropractic is manual medicine, like osteopathy, physical therapy, or massage. Internal medicine, vaccines, drugs and surgery are out of scope of practice for chiropractic.
Chiropractic’s fundamental philosophy is that the body heals itself, and a chiropractor simply pushes the body in the right direction. Spinal alignment and proper joint movement enable the nervous system to operate properly. A solid understanding of anatomy and diagnosing requires science principles, the didactic book learning aspect. Chiropractic treatment and assessments has a degree of art to it, which takes practice and experience to develop.
History:
LMNOPQRST - Location, Mechanism of injury, Nature of injury, Onset (acute or chronic), Palliative/Provocative, Quality of pain, Radiating pain, Severity of pain, Time is a useful mnemonic addressing patient history taking. A chiropractor typically begins interacting with a patient by assessing signs and symptoms and asking appropriate questions. A patient narrative is established. History taking is an important first step toward establishing a diagnosis and developing a treatment plan.
Family History and Past Medical History can also be included as part of the patient history assessment. Past medical history can become important if, for instance, a patient is on medication like coumadin, a blood thinner which would contraindicate chiropractic care. Varicose veins are another example where massage is a contraindication to therapy because it risks blood clot material entering the bloodstream.
Today’s fake pandemic and disastrous Covid-19 “vaccine” rollout, requires this important history evaluation question “have you taken the Covid-19 jab.” Someone told me he had a stroke a few months ago. My first question was – did you take the jibby jab? Vaccine Adverse Events Reporting (VAERS) system suggests serious and severe injuries. https://www.openvaers.com/covid-data. Did you know there was antifreeze in the jibby jab? Did you know that medical error is the third leading cause of death?
Bedside manners require tact. Since drugs and vaccines are out of chiropractic scope of practice, there is little I can do, other than to recommend to never accept a vaccine – ever! The best I can do to help is to recommend doing your own homework. Dr. Lee Merritt is my favorite doctor - https://drleemerritt.com/
Interesting links:
1-Denounce the vaccine, 2-Pray over your food for cleansing, 3-Prayerful intention for supplements.
Angelic realm is helping those that have luciferase from the Vax tearing their souls from God.
Inspection:
Inspection includes having a person walk in place and then stand still in a comfortable relaxed position. The picture below on the left demonstrates someone having cervical left rotation. Whereas the picture on the right demonstrates someone having right lateral flexion. These two pictures can suggest a postural alignment problem, which may or may not be asymptomatic.
The first half of cervical rotation occurs with the Atlas (C1) rotating on the Axis (C2). The suboccipital muscles moves, rotates the atlas on the axis. Whereas scalene muscles provides lateral flexion. The scalene muscles assist in breathing when on demand, heavy breathing, because of the attachments to the top ribs. Nerves coming out of the spinal cord to form the brachial plexus must go through the scalene muscles, hence “pinched nerve” potential.
A visual static inspection assesses posture. A visual dynamic inspection assesses gait, how one walks, which could reveal muscle imbalance. As an example, if someone walks with one foot toeing out, that suggests excessive external rotation at the hip joint, which is often due to a tight piriformis muscle.
Palpation:
Palpation is an essential skill for a chiropractor, because assessing joint movement within the cervical (C1-C7), thoracic (T1-T12) and lumbar (L1-L5) vertebrae is done through palpation. Palpation assesses proper joint play with the shoulder, elbow, wrist, hip, knee, ankle, etc. etc. Palpation can be an art to master.
Myofascial trigger points are taut bands of muscle fibers and can be palpated on many muscles. Abusing or overly using a muscle can cause trigger points.
CranioSacral Therapy was developed by John Upledger, D.O. The heart pumps blood at a pulse rate of 60-100 beats per second as the normal rate. The brain has a cranial sacral rhythm of 12 to 20 pulses per second, which is the manufacturing and reuptake of cerebral spinal fluid. Physical labor may increase your heart and lung rate because of increased oxygen demand but has no effect on cranial sacral rhythm. Strange as it may sound, it is possible to palpate a cranial sacral rhythm, though it is subtle to discern and requires focused attention to your hands and ignore all other sensations. Subjugate the ego.
Percussion:
Sound from tapping on the back where lungs are. Rarely used.
Range-of-Motion:
A goniometer is a tool to measure range-of-motion of synovial joints. All synovial joints are surrounded by a joint capsule. The web link below provides nominal values in degrees.
Skeletal muscles attach bone to bone through tendon to consciously enable dynamic movement. Ligaments attach bone to bone and provide a static limit to range-of-motion, providing a checkrein on movement. A strain is a tendon tear, whereas a sprain is a ligament tear.
Michael Leahy, DC, ART, CCSP, is the founder of “Active Release Technique” (ART), which is a collection of protocols for treating numerous muscles and ligaments. ART is a highly effective method of treating myofascial trigger points. Briefly, a muscle is brought to its shortest position while contacting the attachment point, and then the muscle is brought to its longest stretched position while maintaining contact.
Orthopedic:
Orthopedic tests, like straight leg raise, are used to rule in or out a diagnosis.
Neural:
Myotome refers to motor, or muscles (and glands). Dermatome refers to sensory, skin and more. The picture below is a “Homunculus,” which, as the picture suggests, maps various body parts to your brain within the central nervous system (CNS).
“Somato” means body. Understand, like a subway train system, that there are outbound signals, meaning brain to muscles, and an inbound signals, meaning sensation (i.e. pain, burn, vibration) to brain. And the two shall never meet! The outbound efferent neuron cell tells muscle to contract or relax. There are significant differences between upper motor neuron lesions within the brain and spinal cord, and lower motor neuron lesions within the peripheral nerves that are outside the spinal column. The inbound afferent neuron synapses at the dorsal root ganglion and forwards the sensory signal to the thalamus, a sort of relay station, and onto the somatosensory cortex.
The “central sulcus” separates inbound signals from outbound signals.
Reflex testing is part of neural assessment. This presentation is a simplified version of a very complex system, the nervous system. Concepts such as pain and consciousness are remarkably deep and way beyond the scope of this post.
Imaging
The ABCs of reading x-rays are Alignment, Bone, Cartilage and soft tissue.
The image on the left is a schematic representation of an ideal lateral view of a cervical spine with normal lordosis alignment. Note the 43° arc drawn between C2 to C7 of a circle and that C2 should be directly over C7.
The image on the right is an actual x-ray of a lateral cervical view. This view suggests hypo-lordosis and forward head carriage, because the vertebral body of C2 is forward of the vertebral body of C7. (I got this x-ray image from the internet, so I don’t know any details of it.)
DON HARRISON, DC, PHD developed Chiropractic Biophysics (CBP)
Lab
Blood work.
The Jibby jab… I’m sure it’s nothing…
Sasha Latypova provides excellent advice on preparing for the next pandemic in this useful post: sashalatypova.substack.com/p/what-does-moderna-know-that-pfizer. Thank you Sasha, you rock and have provided outstanding information regarding the scamdemic.
