Cindy Howard, DC, DABCI, FIAMA, uses innovative diagnostic methods to help treat patients inside and out

To assist in diagnosing spinal and other skeletal problems, Cindy Howard, DC, DABCI, FIAMA, Innovative Chiropractic and Alternative Healthcare, Orland Park, Ill, uses the motion palpation technique.

“The basis behind motion palpation is to determine which joints aren’t moving properly by assessing every joint by hand,” Howard says.

Dr. Howard and her partner and husband Steven Zaeske, DC, DABCI, are among a small group of DCs with the DABCI credential.

The technique can be used to find dysfunction in the spine and extremities.

The patient sits, stands, or lies prone while Howard assesses motion of a joint segment. Though it is one of her primary diagnostic techniques, motion palpation, as Howard is quick to point out, is one of the last exams she does. It usually follows an orthopedic and general examination. However, “Motion palpation is more specific in locating the segment I wish to adjust on the patient [than the other exams],” she says.

For example, if a patient comes in complaining of cervical pain, Howard first completes a general exam, which includes checking the patient’s eyes, ears, nose, throat, chest, and abdomen. Then she checks muscle strength, reflexes, and pain sensation. Included is a neurological workup. All of this is to assess the extent of trauma, particularly if the patient is unclear about the cause of the pain.

Included in the workup are imaging studies, which are done at a local hospital.

Motion palpation, which Howard learned during her formal academic training, has numerous benefits. For Howard, the sensation of touch is one of its biggest. “It helps me in terms of touch, feeling for [dysfunction],” she says.

Howard typically does motion palpation first, then she does the adjustment on the patient—she uses the diversified technique—then reassesses the patient with motion palpation again. “That way, I can make sure that I did the adjustment [adequately],” she says.

Motion palpation has another benefit. It allows Howard to make sure that the area that she is adjusting is appropriate. “I want to be specific with my adjustment,” she says.

Though Howard says that anyone can learn motion palpation, she says those who are best at motion palpation are those who have a knack for hands-on treatment.

How It’s Done
Although the technique can be done on patients in various positions, motion palpation is usually performed with the patient sitting on the table with Howard behind them. With one hand, she stabilizes the patient’s forehead as she motions the cervical spine. The stabilizing hand then moves across the patient’s shoulders as Howard motions the thoracic and lumbar spine as well as the sacroiliac joints, noticing lack of mobility in each spinal segment, or hypermobility. This helps her determine which segment to adjust. Movement can be assessed from posterior to anterior, in lateral flexion and rotation for most segments. Motion palpation can also be done on extremities and is done in all planes that a joint is capable of moving through.

Motion palpation is not the only diagnostic technique that is used at the practice. Howard’s partner in practice, her husband, Steven Zaeske, DC, DABCI, also uses applied kinesiology.

Howard does not use motion palpation as a marketing tool, though it does help retain many patients, particularly those who expect a physical examination to actually have a physical dimension.

But motion palpation is only one thing that makes Howard unique as a chiropractic physician. Her ability to treat the entire patient puts her in an elite group.

Inside and Out
When patients visit Innovative Chiropractic and Alternative Healthcare, they fill out a comprehensive medical exam form and give their full medical history—including their current complaint. They are given a visual analog scale or pain picture to complete. Vital statistics are taken on every patient. Blood work or other tests are ordered if medically necessary.

This approach to chiropractic, though different than that offered by many chiropractors today, reflects the roots of the profession “when chiropractic physicians treated everything,” Howard says.

Howard, a chiropractic internist, assesses and treats ailments that occur inside the body, and performs more traditional chiropractic treatments—such as adjusting the spine. In addition to laboratory testing—such as blood panels—Howard also administers electrocardiograms, and does lung studies, venous studies, and other treatments more commonly found in the medical internist’s office.

All treatments for internal complaints are in the realm of “alternative” medicine, meaning that the medicines used include vitamins, minerals, and herbal and homeopathic remedies. Howard is also certified in medical acupuncture and uses that to treat various maladies.

Howard and her partner and husband, Zaeske, are among a very small group of chiropractors who hold the DABCI credential, or Diplomate, American Board of Chiropractic Internists. Howard estimates that the number ranges from 200 to 250 nationwide.

The postgraduate training required Howard to take a 300-hour, 3-year course of study. The site of the training program moves on a regular basis. It is currently offered in three states: Missouri, North Carolina, and Texas. More information on the program can be found at www.councildid.com and www.drkessinger.com. This is to facilitate participation, giving chiropractors several attendance options in central locations. The certification is good throughout the United States, though the ability to treat the full extent of maladies is limited by laws in each state.

Howard was inspired to follow this course while an undergraduate during a course on gynecology. The idea that she could do more than adjust spines excited her. “There are so many things that I can do,” she says. “It’s fun. Every patient and every problem is different.”

The ability to treat patients inside and out gives Howard various options when diagnosing patients. Howard, who is also president of the American Chiropractic Association Council on Diagnosis and Internal Disorders, may recommend a number of tests during her preliminary examination that allows her to make a full assessment of a patient’s health.

A nutritional blood analysis is more thorough than the typical blood panels taken by a medical internist. One difference with Howard’s test is that instead of measuring the patient’s blood data against the accepted “clinical ranges,” she measures patients based on the “homeostatic” range. The latter is the range found in healthy people, and it identifies nutritional needs and suboptimal organ and gland functions.

Food allergy/sensitivity testing is a blood test that identifies so-called hidden allergies that may go undetected using the traditional methods, such as skin testing.

The gastrointestinal health assessment is a stool test used to identify microbe and yeast problems, inflammation, and “leaky gut.” It also measures positives—healthy bacteria, among them acidophillis and biffidus—and finds immuno-deficiencies within the gastrointestinal tract.

Adrenal stress testing identifies potential problems with those glands. PH testing can identify if a patient’s chemistry is too acidic.

Female hormone testing helps older women choose the ideal types of natural hormone-replacement therapy that is best suited to them.

Hair biopsy is one of the other toxin tests that Howard runs. In this test, hair from the back of the patient’s neck is measured for toxins in their body. Amino acid analysis, likewise, measures the amount of these important neurotransmitters in the patient.

Howard offers vaginosis cultures and pap tests as options for women. The test identifies the various organisms that can cause recurrent vaginitis. The results of this test help determine one of several alternative therapies available to treat this condition.

Electro meridian imaging (EMI) is an acupuncture test using no needles. It measures the electrical strength within the acupuncture pathways or meridians. Since the practice began offering this measurement, the number of acupuncture treatments patients have needed have decreased.

Acupuncture muscle testing requires no use of needles. This is not a diagnostic test, but is used to evaluate how the patient’s body reacts to the energy of certain substances. If a particular substance is held over an acupuncture point and it reacts negatively, then it is believed that the patient’s body will not react well to the substance.

The specialization in internal medicine helps Howard compete in a rather crowded market. Eight chiropractors are located within a mile of her practice. Her attention to the whole body gives her an edge over her competitors. “You can’t get that much attention from anybody else,” she says. “And it allows us to have a well-rounded practice.”

Howard’s practice is targeted at the entire family. Though she cannot treat patients with narcotics, she sees herself as the first point of care for her patients. “Everybody should come to us first to figure out what’s causing their symptoms or conditions, and then we can treat naturally,” she says. “If needed, we do refer within and outside our profession for any additonal care.”

A chiropractic internist has a holistic approach to health and typically measures five key areas as to the health of a patient. They are digestion, absorption, and healthy bowel function; optimal organ and gland function; nutrition; allergies and immunity; and toxicity (the latter measures whether or not toxins from the environment have entered the body).

Howard and several medical doctors refer patients to one another. She coordinates care if a patient, for instance, is on medication that could interact with one of the herbal remedies that she might prescribe.

Among the common conditions Howard treats include food allergies, irritable bowel syndrome, inflammatory bowel diseases, candidiasis, dysbiosis, premenstrual syndrome, menopausal complaints, recurrent yeast/bacterial infections, attention deficit hyperactivity disorders, recurrent ear infections, asthma, eczema, psoriasis, migraine headaches, diabetes, chronic sinusitis, rheumatoid arthritis, and fibromyalgia. Treatment is limited to addressing problems and getting patients well, which typically takes a few weeks.

Howard’s arsenal of techniques also includes fellowship training in acupuncture. She is a fellow of the International Academy of Medical Acupuncture. She uses acupuncture to treat ailments such as back pain, infertility, sinusitis, gastrointestinal problems, postsurgical pain, carpal tunnel syndrome, and headaches. The practice uses traditional needles, and lasers as well. The advantage of the laser approach is that because it is subsensory, no pain is felt.

Although the practice offers “alternative” treatments, it has contracts with several of the major health insurance providers in the area, including Blue Cross Blue Shield, Cigna, and Aetna. “We’re reimbursed for most of our treatments,” Howard says. CP

C.A. Wolski is a contributing writer for Chiropractic Products.