Doctor induced variables in the supine Spinal Balance Test (leg check). For patient induced errors
As a preface, we would like to pass on a statement made by Dr. Earl Striplin (an instructor in Grostic technique in the 60’s): "One of the things I’ve found out by traveling around the country teaching this work is that everyone knows how to check legs."

Dr. Striplin was being sarcastic, of course. But the truth is that everyone is sure of his or her leg check because what they see is what they see, right in front of them. There it is, Rt.1/2. But is it really Rt.1/2?
Fact is: the Spinal Balance Test is a very subjective test that has within it many inherent variables. Because the D.C. saw the leg deficiency before his or her own eyes, it became real - a real factor which has been given an exponent (R1/2, L1/2) whichever the case may be - regardless of the errors that were employed to produce it. This very often leads to confusion and drifting into other areas of the spine, not to mention the employment of worthless modalities in order to produce temporary symptomatic change.

The importance of the S.B.T. in patient management, and therefore practice success, cannot be over estimated. Also, as we have mentioned previously on this web site, it has been our observation, based on over forty years of experience, that, unless constantly monitored with attention to the fundamentals and with the DC’s ego on the shelf, the ability of the DC to perform a consistently accurate S.B.T. will inevitably deteriorate. Further, this deterioration is usually quite rapid, producing wide discrepancies from the reality of what is actually going on in the patient’s nervous system.

Given that attention to the fundamental and to consistency is extremely important in any practice, in a practice such as ours, where we have five doctors on our staff with patients often moving from one DC to another because of time-slot, a uniform, consistently accurate S.B.T becomes a sina qua non. In other words, one of the staffs of life of our practice.

Because of this, in our offices we have frequent S.B.T. drills among the doctors, checking the fundamentals. (See B.J.’s writing on Slipping and Checking. We consider this to be a very valuable piece of advice, applicable to all phases of practice. If you do not have a copy of this insight, e-mail us and we will be glad to send you one.)

The following are some of the major sources of variables that we have found in the application of S.B.T.: There are others, but these are the majors.

1. Not having DC’s coronal plane (shoulders and hips) perpendicular to patient’s saggital plane.
2. Lifting the legs / feet -- causing tension in the patient’s legs.
3. Slouching. The doctor’s spine should be kept straight. Doctor should tuck chin down to get a proper look.
4. Unbalanced head-ward pressure.
5. Forcing removal of foot-drop.
6. Fighting the ankles / knees to overcome tension. A light touch is preferable. A practiced light touch will usually cause the patient’s knees/feet/ankles to be quite easily guided into a reasonable checking position.
7. Thumbing - too much thumb pressure on the lateral malleoli.
8. Using the doctor’s wrists and hands to remove foot drop / rotation, instead of using the doctor’s shoulders arms and wrists. Shoulders arms and wrists should become one unit that is stabilized by resting the forearms on the (doctor’s) thighs.
9. Releasing head-ward pressure on one foot while you set up the other foot.
10. Forcing the patient’s legs in together when they have too much inner thigh bulk. Ideally heels should be touching each other when set-up is started, but this is impossible with large patients.
11. Using wrong reference planes on patients shoes to "eye" differential. Reference line is where the "last" of the shoe is sewn into the sole. All other reference points tend to be variables.
12. Setting up too close. This causes the doctor to lean back in order t to look down the right plane.
13. Setting up too far back. This causes the DC to lean forward in an ungainly angle in order to get the proper eye angle.

Remember, your adjustment is only as good as the time factor in your delivery.