Naprapathic functional diagnostics are based on the fundamental idea that if a movement dysfunction in the spine or peripheral joints persists, there must be something maintaining this dysfunction. Otherwise, the function would normalize spontaneously and not give rise to any clinical symptoms.
A movement dysfunction refers to either hypomobility (reduced mobility) or hypermobility (increased mobility). According to naprapathy, this can be caused by ligament shortening or ligament injuries, increased or decreased muscle tone, fibrosis of connective tissue, intra-articular adhesions, scar tissue, loose body fragments, cartilage erosion, and discogenic injuries, etc.—that is, changes in connective tissue.
An abnormal condition in connective tissue and muscles prevents joint surfaces from moving in one or more directions. The relationship can also be the opposite, meaning that stretching of these tissues can lead to increased joint mobility or create instability. It is therefore just as important to identify areas where motion-increasing treatment should be avoided as it is to identify areas where such treatment is indicated. The affected joint should sometimes be treated with motion-increasing techniques and sometimes with stabilizing techniques.
The importance of a correct diagnosis was emphasized early on in naprapathy, and the ability to diagnose is of the utmost importance. Although humanity exhibits generalities, every person is unique, which is why it is important to choose the right therapy for each patient.
The naprapath strives to optimize the function of joints, muscles, and nerves, taking the individual's circumstances into account.
The naprapath examines connective tissue, muscles, and nerves in various ways, ranging from a detailed medical history and standard orthopedic and neurological tests to a naprapathic examination of the spine and/or peripheral joints, which includes muscular tests, functional nerve tests, and joint-specific motion tests. If supplementary examinations are needed, the naprapath refers the patient to other healthcare providers.
When assessing a patient, the naprapath always begins by listening to the patient's medical history (anamnesis). The purpose of the anamnesis is to build a picture of why the patient is seeking care and what might be causing their symptoms.
The naprapath is also observant of potential differential diagnoses for the symptoms, as well as any contraindications for treatment. During the history-taking, an initial assessment of the patient's general condition is made, which is later supplemented during the clinical examination.
The naprapath listens to the patient's description of their condition and then asks follow-up questions to gain deeper insight into the problem based on what the patient has shared. This also includes questions of a differential diagnostic nature, as well as the identification of so-called "red flags" (serious pathology) and "yellow flags" (psychosocial factors) that may influence the symptom profile.
Is there a clear mechanism of onset that can be linked to the start of the symptoms, or was the onset gradual? Have the symptoms occurred before? Are there other previous neuromusculoskeletal complaints or illnesses that may contribute to the development of symptoms? Is the patient on any medication? Is there a family history of these complaints? Have previous investigations and treatments been performed? It is also important to clarify when, where, how, and for how long the problem has existed. These and similar questions are asked during the first visit. Depending on how long the patient has had the symptoms, the complaints are classified as acute, subacute, or chronic, which influences the choice of treatment strategy.
The naprapath summarizes the patient's medical history during the anamnesis, which is an effective way to confirm that the naprapath has correctly understood the patient's complaints. The patient can then add information or clarify if anything was misunderstood or missing before proceeding with the examination. It is important for the naprapath to understand the physical symptoms the patient is suffering from, but also to understand the patient and how they experience those symptoms.
The naprapath explains the examination process to the patient and what they can expect from it. Ongoing communication is maintained throughout the procedure so that feedback can be provided as various tests are performed.
The purpose of the examination is to confirm or rule out the preliminary diagnosis and suspected cause of the patient's symptoms based on the medical history, as well as to identify any potential pathology or conditions not suitable for naprapathic treatment. The goal is to establish a diagnosis based on the patient's history and examination results, which serves as the foundation for further treatment.
Through the examination and medical history, the naprapath primarily aims to determine whether there is serious spinal pathology, nerve root pain, or radicular pain, or if the issue is a functional neuromusculoskeletal problem.
The naprapath begins the functional and structural examination centrally (closest to the spine) before moving on to peripheral structures, unless it is obvious that the injury is solely peripheral with a clear mechanism of onset (e.g., a sprained ankle, muscle strain, etc.). The better the naprapath is at making an accurate diagnosis—that is, finding the root cause of the patient's complaints—the more precise the choice of treatment will be. With the right choice or combination of manual techniques, the treatment intervention and healing process are optimized. The prognosis naturally also depends on other factors, such as the patient's individual circumstances and environmental factors.
The naprapath attempts to determine whether there is an injury to a specific structure (disc herniation/protrusion, ligament rupture, muscle rupture, etc.) or if the structure has altered function, which is the cause of the patient's symptoms. Impaired function can lead to a structural injury, either locally or in another part of the neuromusculoskeletal system. The situation can also be reversed, meaning a structural injury causes impaired function in local structures or elsewhere in the neuromusculoskeletal system, which then becomes symptomatic.
To determine which structure and/or function should be treated—that is, which treatment plan is appropriate—the naprapath performs both structural and functional tests. This examination includes conventional neurological and orthopedic tests, naprapathic motion-specific functional joint tests, muscular tests, and functional nerve tests. The examination includes both active and passive movements.
Based on this comprehensive examination, the naprapath makes a structural and/or functional diagnosis and creates a treatment plan accordingly.
To some extent, original naprapathic examination methods and mapping models are still used, meaning that modern naprapathy has clear historical links to the "Triple C" principle introduced by the founder of naprapathy, Oakley Smith.
