Evaluation - Do I have this pattern?
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Self evaluation:

Facing a mirror, stand back about six feet and place your fingertips on the most forward points of your hip bones. The left side will be higher. The tops of your hips on the side will be level.

Sit, with the person you are evaluating standing facing you. Place your thumbs on the points of their two hip bones in the front. Their left side will be higher. The tops of their hips on the side will be level. Shorter individuals can be best assessed when positioned so that their pelvic girdle is at the examiner’s eye level.

Visually, the left shoulder will often be higher and further back than the right shoulder. The left ear and the left eye will be higher than the right and the left eye can appear narrower as in squinting. The eye and ear differences can be most accurately seen with the individual lying on their back and the examiner at the head facing the feet. Position the head so it is in alignment with the rest of the body and look straight down at ear and eye levels.

Detailed assessment: for properly trained and qualified health care professionals only.

(A) VISUAL:

This actually begins the moment you meet your new patient. Once you become familiar with this phase, you will be well on your way to an accurate assessment of your patient’s signs and symptoms before you even enter into the hands-on aspect of the treatment.

Look closely at the eyes, the ears, facial symmetry. Watch your patients as they stand and walk into your office, look at shoulders, waistlines, anterior and posterior, for A.S.I.S., P.S.I.S. (Anterior/Posterior Iliac Spine) alignment. If you don’t find these or other components of the Pattern on your initial examination, look differently, and look again. The signs can be subtle, but in most instances they will be there.

A.S.I.S. asymmetry can be best demonstrated with the aid of a wall-mounted mirror. Patients will be able to see and feel these differences for themselves.

Stand the patient five or six feet back facing the mirror (shoes off). Kneel in front of the patient to position their pelvis at your eye level. Place your hands on the tops of the iliac crests. They will be level. Next, land mark the patient’s A.S.I.S.’s with horizontal thumbs, moving out of the way in each instance to enable the patient to see the land marked alignment. The left A.S.I.S. will be superior.

(01) EARS: The left ear will be superior to the right. The upper, close approximation of the left ear indicates posterior (internal) rotation of the left temporal. This is often difficult to see initially. If in doubt, wait until your patient is supine. position the head so it is in alignment with the rest of the body then stand at the head looking straight down at ear and eye levels. The difference in ear height is usually much more apparent than the difference in eye height. The lower protruding right ear suggests apparent external rotation of the right temporal. 

(02) EYES: The left eye will be superior to the right. As with (1), this is a result of the internal rotation of the left temporal bone and/or the apparent external rotation of the right temporal bone. This can be even more difficult to see at first as the difference in eye heights will be significantly less than the difference in ear heights. As in (1) above,  wait until your patient is supine. The left eye may also appear as if partially closed.

(03) CRANIUM: Will appear less rounded on the left, more on the right. This is believed due to the internal rotation of the left temporal bone and the apparent external rotation of the right temporal bone. To see this asymmetry more clearly, place your hands palm up at the side of the patient’s face, making contact just below the ears. You should be able to discern this difference more easily. 

(04) SHOULDERS: The left shoulder will commonly be seen to be posterior and superior compared to the right shoulder. 

(05) HIP ROTATION: The left hip will appear to be rotated posteroinferiorly. The left A.S.I.S. will be superior, and possibly anteromedial. The left P.S.I.S. will be inferior and possibly anterolateral. The Iliac crests will be level.

(B) PHYSICAL:

PATIENT PRONE 

(06) LUMBAR, SACRAL, GLUTEAL REGIONS: The left side will present markedly greater density, ropy consistency, tenderness and active trigger points, Quadratus Lumborum in particular. The right side will routinely palpate as normal healthy muscle with the common exception of one specific point of tenderness in the lumbar region, present approximately 60% of patients seen, located approximately two thirds of the distance superiorly from the iliac crest to the lower rib. Right SI joint area may also be hypertoned and tender.

(07) PELVIC GIRDLE: If rotated, will be clockwise when viewed from the head.  Prone: the left P.S.I.S. will be anterior and slightly lateral. Supine: viewed from the head, the pelvis will be seen to be rotated in a clockwise direction, and the left A.S.I.S. will be anterior and medial relative to the right.

(08) LOWER EXTREMITY NUMBNESS, PAIN: Most common on the left side. Sciatica or sciatic pain is a common misdiagnosis. Referred pain from trigger points in quadratus lumborum, gluteal muscles, etc. is more often the cause, particularly when Pattern effects are extreme and/or longstanding. Right side has on occasion been reported to have been the side of most pain/discomfort. In most instances, the left Pattern will still apply and correction of this will relieve the right side signs and symptoms. 

Leg length discrepancy seems to be a common misdiagnosis. To be horizontal and balanced, the pelvis must be supported by legs of equal length. If there was a true leg length difference, the obliquity would have to be apparent in the level of the Iliac Crests. In this Pattern, the Iliac Crests are level. The obliquity in the positioning of the innominates creates the illusion of an apparent discrepancy in leg length. Some degree of scoliosis is common where the pelvic torsion is chronic and/or pronounced. With this Pattern, there will be a primary left lumbar curve, and secondary, compensatory right mid-lower thoracic and left upper thoracic-lower cervical curves. It responds favorably to the Pattern treatment approach.

(09) MID-LOWER THORACIC: The right paravertebral muscles will present markedly more density, ropy consistency, tenderness, and trigger point activity Compare left and right mid and lower thoracic paravertebral area musculature. Differences may often be less apparent, less significant or nonexistent relevant to other area findings. If present, the right side will be more sensitive to cross-fiber pressures and will have greater density, mass and may protrude posteriorly creating a hump. Referring trigger points are less common in this area.

(10) UPPER BACK, INTERSCAPULAR: The left interscapular muscles will present markedly more density, ropy consistency, tenderness, and trigger point activity. Compare left and right interscapular, then posterior scapular, shoulder girdle area musculature. Patients have on occasion reported more problems with the right side in this area, however palpation and patient response in most instances ultimately revealed the left side pattern.

(11) UPPER THORACIC: Compensatory counterclockwise rotation is possible, when viewed from the head. Prone: Observation of the mid-lower thoracic region may show a posterior (rib) hump, the most common being right side posterior due to compensatory vertebral rotation. Supine: Prominence of the rib cage can also be noted along the anterior aspect of the chest on the concave side of the curve, the most common being right side anterior. Compression of the ribs occurs on the concave side of the curve, and separation of the ribs occurs on the convex side because of the rotation of the vertebrae and rib cage. The net result, which is accentuated with forward bending, is prominence of the ribs and scapula posteriorly on the convex side of the curve.

(12) UPPER EXTREMITY NUMBNESS/PAIN: Most common on the left side. Scalenes and posterior scapular region muscles are almost always involved, usually more on the left although this has on occasion been reported to be right side and/or bilateral.

PATIENT SUPINE

(13) EAR AND EYE ALIGNMENT: The left eye and ear will be superior. Position the head so it is in alignment with the rest of the body then stand at the head looking straight down at ear and eye levels. The left eye and ear will be superior. The difference in ear height is usually much more apparent than the difference in eye height. This is a result of the internal rotation of the left temporal bone and/or the apparent external rotation of the right temporal bone. The left eye may also appear as if partially closed. 

(14) ANTEROLATERAL NECK: The left anterolateral neck will present more ropy consistency, tenderness and trigger point activity, involving the sternocleidomastoid and scalenes muscles in particular. There will be marked differences between left and right sides in this region. Common to elicit sternocleidomastiod referrals into the left upper extremity and scalene referral patterns into the right upper extremity.

(15) POSTEROLATERAL NECK: The right posterolateral neck will present more ropy consistency, tenderness and trigger point activity, particularly the superior aspect, including the sub-occipital muscles. There will be marked differences between the left and right sides.  

(16) FROM A CRANIAL PERSPECTIVE: Restricted rhythm, movement on the left. The left temporal will show restriction: posteriorly/internally rotated. CAUTION: DO NOT attempt cranial techniques unless you have been properly trained and qualified in their application.

(17) TEMPOROMANDIBULAR JOINT  RESTRICTION: Where this is present, it appears most commonly on the left although it may initially appear or be reported as being right side. It is generally a direct response to the posteroinferiorly rotated left temporal bone and responds well to pelvic realignment, often without direct TMJ treatment.

(18) HEAD PAIN: Headaches and other forms of head pain are most commonly reported as starting in the right suboccipital and posterolateral neck regions. Sternocleidomastoid, upper trapezius and suboccipital muscle trigger points routinely reproduce the headache symptoms.

(19) VERTIGO, DIZZINESS, BALANCE: Common when (1) Eyes, (2) Ears and/or (3) Cranium  misaligned as detailed earlier. Cranial faults related to the temporal bone can disturb equilibrium by causing the right and left semicircular canals to be mechanically disoriented with each other. Tends to worsen as pain increases in head and neck pain situations, decreasing as pain and concomitant muscle tension lessens. Where it is directly related to the posteroinferior rotation of the left temporal bone, this responds favorably to this approach with its concomitant repositioning and balancing of the temporals.

(20) KNEES: Left side.  The specific area will be just superior to the knee joint, at or near the medial hamstring attachment. Tenderness is common, can be bilateral but is almost always greater on the left side. 

(21) ANKLES: Left side. There will be an active trigger or tender point, located on the inferior slope of the medial malleolus. Can be bilateral but generally most prominent left side. 

(22) FEET: Left side. Plantar surface, medial arch. Plantar fasciitis is common bilaterally but usually is most severe on the left.

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