• observation
• questioning and listening
• diagnosis
• recommending treatment.
Observation should include both observations of the body generally, and detailed observation of the feet.
General observations
General appearance should always be noted; this can only be achieved by a methodical scrutiny of the person as described below to give some idea of their problem.
Being aware of and paying attention to the movement and the physical mannerisms of the person entering the room is of the utmost importance, as many things are noticeable in the first few minutes. These are important as people do not consciously adjust their movements or their mannerisms whilst unaware that they are being observed.
When walking, for example, do they walk on their heels? This could indicate hypersensitivity in the plantar region of the foot, which may indicate peripheral neuropathy. If there is a spring in the step it indicates that the supportive ligaments and muscles are well developed and there is less probability of a spine problem. Is the person flexible in movement when walking? This is a good sign and it shows there is little tension in the body. If the reverse is evident it often indicates the patient is stiff and rigid, and shows that the muscles are tight. This could be due to a muscle injury, a neurological disorder and even arthritis affecting the joints.
The position of the head is important to note. When the body is in the correct position the head is straight and lifted up, the shoulders are relaxed, and this indicates a lack of tension in the person. When the body leans forward it may create pressure on the cervical region, and pressure on the frontal area of the brain; this is thought to be a contributing factor to depression. It also causes pressure on the lower lumbar spine because the weight is not central. The word ‘depression’ means ‘pressure’ or ‘weighing down’; a posture with a dropped head and hunched shoulders may signify that the person is in a low state of mind. Such a posture can in turn cause pressure on the thoracic cavity and abdominal organs. If the shoulders are drawn in the breathing capacity is also diminished; this lowers and impairs the ability of the circulating blood to reach all areas of the body. Many of the problems associated with rounded shoulders are those linked with respiration, such as asthma, bronchitis and upper respiratory infections.
When clients are seated, the therapist should note the following. Are they relaxed? Are the hands held still and at ease, showing a state of calmness and peace, or are they fidgeting, squeezed or twisted in a wringing action, showing unease and discomfort? Other visible signs of unease include plucking of hair and other movements. For instance, do they cross and uncross their legs, cross their feet, or move around? Attention should also be paid to clients’ speech. For instance, do they speak fast without drawing a breath? What is the tone of the voice; is there modulation, or is it high pitched?
All of these behaviour patterns could indicate unease, but there are other explanations. For instance, continual leg movements could be due to discomfort in the lower back or hip area. We should not make a hasty diagnosis, or jump to conclusions. However, the initial observation should enable the therapist to begin to form an assumption of what the problems may be.
A number of specific features can also be observed and are particularly significant.
Facial skin colour and tone
Difference in skin colour is due to the amount of melanin pigment in the skin. However, a good pink facial colour in fair-skinned people is a sign of a healthy circulation and general good health, as the colour of the skin also depends on the quality and quantity of blood moving through the capillaries. Erythema or redness of the skin can be due to many factors; for instance, the client could have rushed to make their appointment, they may be a little embarrassed, or there could be some allergic reaction (as in hives where the skin is often red and irritating). Any undue redness of the skin should be therefore investigated further. Pale skin may indicate a reduced blood flow, or excess time spent indoors, or just that person is enervated by their problems. A grey appearance may indicate illness or total exhaustion; it could even be caused by a lack of oxygen due to respiratory problems. A greying colour can also occur after a sudden shock.
Dry skin or moistureless prematurely aged skin may be indicative of a hormonal imbalance or that the diet is lacking in some nutrients. Any acne, pustules, pimples and spots is nature’s way of discarding toxins through the skin. They indicate that the endocrine system may be out of balance, and diet, hygiene and lifestyle may need to be addressed. If the problem is acne, the sebaceous glands may have become blocked, or it could also be due to an allergic reaction to other substances.
Ears
The ears should have the same colour and tone as the facial skin. However, if there is a slight red tinge around the edges this could indicate an uneven blood circulation. If there is a bluish discoloration it may indicate a lack of oxygen and a deficient circulation. Pallor of the skin here in comparison to the face also shows inadequate circulation. (Note, however, that the outside temperature must be noted when doing ear analysis.) Dry skin or exfoliation of the upper layer indicates a possible imbalance in the diet. (See chapter 7 for more information on the ear.)
Hair quality
Good health is shown by bright shining hair; poor health is indicated when the hair is dull and lifeless. If the hair is thinning excessively there could be an immunological disorder; this could also occur after an illness, or even excessive dieting. Brittle hair could signify a mineral deficiency or endocrine imbalance, because the endocrine system is responsible for the stimulation of the sebaceous gland – sebum helps hair from drying out, but too much sebum can create oily hair.
Lips (labia)
The lips should be moist and of a pink healthy colour; this indicates good health and good circulation to the peripheral parts of the body. As the lips are extremely sensitive and have numerous sensory receptors they are often prone to allergic reactions from cosmetics, which can make them appear cracked, dry and sore looking. Also it is necessary to see whether the person produces sufficient saliva (see below), as this also aids lip moisture. How lips and mouth are held gives a good indication of how the person feels; tight pursed lips often indicate tension or unhappiness.
Mouth (buccal cavity)
A dry mouth can be due to incorrect breathing through the mouth, or lack of saliva. This watery secretion containing enzymes begins the process of digestion, and a lack of this secretion could cause constipation or sluggish bowel action. The secretion is entirely controlled by the nervous system, so can be affected if the person is overstressed. It usually indicates that the sympathetic and parasympathetic nervous systems are not in tune with each other.
Tongue
It is not in the remit of the therapist to take over the diagnostic role of the medical practitioner. However, certain signs do help make an overall assessment of the client’s general health. A large flabby tongue often indicates general weakness or possibly the onset of some debility. A furred tongue is often evident if the person constantly breathes through their mouth or is a heavy smoker. In some cases a thick tongue coating could signify a gastric disorder or some other disorder that may be in the process of manifesting. An even, red and shiny tongue could be due to a nutritional disorder. Constipation or an imbalance in the bowels can also cause cracks and crevices together with a heavy coating that appears yellow and brownish.
Eyes