The most simple case of uneven distribution is perhaps that resulting from hip replacement in serious coxarthrosis. Orthopedist Dr Gianluigi Da Campo examined nine patients before surgery and found, as expected, a higher concentration of points on the ipsilateral ear representing the hip which had to be replaced (Fig. 9.9). After 2 weeks, the pain decreased in intensity and this decrease was paralleled by a reduction in the number of tender points. After 3 months, the concentration of auricular points was higher on the non-operated side (Fig. 9.10). This may be due to the change of posture shifting the body's weight to the contralateral side in the recovery phase and/or to the sensi-tization of the contralateral hip area corresponding to degenerative changes of the same type. What is noticeable in Da Campo's research is the sensitiza-tion of the cervical and shoulder area also. This phenomenon might be interpreted as the expression of either general postural imbalance involving also the neck muscles or muscular strain caused by the daily use of crutches.
The most complex asymmetries of auricular points, however, concern postural disorders associated with the onset of myofascial trigger points.
The reader will allow me to make a digression concerning the practice of posturology, which relies on interdisciplinary collaboration aimed at resolving the problems of a patient frequently affected by recurrent pain disorders of the cervical and lumbar areas. This interdisciplinary approach to the patient with postural problems was introduced by chiropractors and osteopaths and was subsequently
further developed by dentists, ophthalmologists and podiatrists. Acupuncturists too play a role in the investigation of postural disorders in patients with recurrent back problems; for example they can individuate and test any scars for a negative influence on the patient's harmonious postural balance.
Returning to auricular diagnosis, it is possible that an uneven distribution of points may lead the practitioner to suspect postural disturbance. The best way to demonstrate this is to examine the patient twice, once lying and once in the standing position. First the patient is invited to lie down for 5 minutes, holding cotton splints between his jaws. This procedure allows him to relax those muscles of the neck, shoulder girdle and hip girdle related to posture. After 5 minutes, investigation of the auricles is carried out using PPT. Any tender points are marked with ink and their location transcribed on the Sectogram. The patient is then invited to take out the cotton splints and stand on firm flooring, remaining still for at least
5-10 minutes: carpets and any soft materials under the feet that could minimize structural asymmetries must be avoided. A second investigation with PPT is then performed and the new points appearing on the auricles are transcribed on a new sheet of the Sectogram.
After 5-10 minutes in the standing position several areas became sensitive, among them the right hip and the left shoulder area, either on the lateral or the posterior surface where the postural muscles of the hip and shoulder girdle are represented. I examined 25 patients with postural disorders of various origins with this procedure. Figure 9.11 shows the new points I found between the lying and the standing position. The right hip and left shoulder areas often correspond to the common pattern of postural disturbance noticeable also in the absence of a shorter leg. In this pattern the right iliac crest often appears raised and rotated forwards as does the left shoulder.
Since postural disorders, especially in patients with chronic disorders, are often caused by multiple
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Fig. 9.10 Distribution of tender points in the same patients as in Figure 9.9 3 months after surgery (unpublished data, with permission of Da Campo). Dots = lateral surface; circles = medial surface.
disturbing factors, it is highly advisable for auricular diagnosis to be accompanied by a thorough clinical examination covering dental occlusion, foot contact with the ground, ocular convergence, etc. An interdisciplinary approach to these kinds of disorders, in collaboration with the specialists in these areas, is therefore recommended.
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