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Symptoms of Spinal Misalignment Questionnaire

Scroll through and click off symptoms you may be experiecing.  Consult Dr. De Luca below.


"The nervous system controls and coordinates all organs and structures of the human body." (Gray's Anatomy, 29th Ed., page 4).

 

Misalignments of spinal vertebrae and discs may cause irritation to the nervous system and affect the structures, organs, and functions which may result in the conditions shown below. Please help us help you by placing a check mark in the appropriate box under the "Possible Effects" column to indicate your symptoms.

VERTEBRAE 1C:
Areas controlled by nerves: Blood supply to the head, pituitary gland, scalp, bones of the face, brain, inner and middle ear, sympathetic nervous system.
Possible effects of a Malfunction:
headache
nervousness
insomnia
head colds
high blood pressure
migraine headaches
nervous brakdowns
amnesia
chronic tiredness
dizziness
VERTEBRAE 2C:
Areas controlled by nerves: eyes, optic nerves, auditory nerves, sinus, mastoid bones, tongue, forehead.
Possible effects of a Malfunction:
sinus trouble
allergies
crossed eyes
deafness
eye troubles
earache
fainting spells
vision difficulties
VERTEBRAE 3C:
Areas controlled by nerves: cheeks, outer ear, face bones, teeth, trifacial nerve.
Possible effects of a Malfunction:
neuralgia
neuritis
acne or pimples
exzema
VERTEBRAE 4C:
Areas controlled by nerves: nose, lips, mouth, eustachian tube.
Possible effects of a Malfunction:
hay fever
catarrh
hearing loss
adenoids
VERTEBRAE 5C:
Areas controlled by nerves: vocal cords, neck glands, pharynx.
Possible effects of a Malfunction:
laryngitis
hoarseness
sore throats
quinsy
VERTEBRRAE 6C:
Areas controlled by nerves: neck muscles, shoulders, tonsils.
Possible effects of a Malfunction:
stiff neck
pain in upper arm
tonsillitis
whooping couch
croup
VERTEBRAE 7C:
Areas controlled by nerves: thyroid gland, bursae in the shoulder, elbows.
Possible effects of a Malfunction:
bursitis
colds
thyroid conditions
VERTEBRAE 1T:
Areas controlled by nerves: arms from the elbows down, including hands, wrists, and fingers, esophagus and trachea.
Possible effects of a Malfunction:
asthma
cough
difficult breathing
shortness of breath
pain in lower arm
pain in hands
VERTEBRAE 2T:
Areas controlled by nerves: heart, including its values and convering, coronary arteries.
Possible effects of a Malfunction:
functional heart conditions
chest conditions
VERTEBRAE 3T:
Areas controlled by nerves: lungs, bronchial tubes, pleura, chest, breast.
Possible effects of a Malfunction:
bronchitis
pleurisy
pneumonia
congestion
influenza
VERTEBRAE 4T:
Areas controllef by nerves: gall bladder, common duct.
Possible effects of a Malfunction:
gall bladder conditions
jaundice
shingles
VERTEBRAE 5T:
Areas controlled by nerves: liver, solar plexus, blood.
Possible effects of a Malfunction:
liver conditions
fevers
low blood pressure
anemia
poor circulation
arthritis
VERTEBRAE 6T:
Areas controlled by nerves: stomach.
Possible effects of a Malfunction:
stomach troubles
nervous stomach
indigestion
heartburn
dyspepsia
VERTEBRAE 7T:
Areas controlled by nerves: pancreas
duodenum.
Possible effects of a Malfunction:
ulcers
gastritis
VERTEBRAE 8T:
Areas controlled by nerves: spleen.
Possible effects of a Malfunction:
low resistance to colds and disease
VERTEBRAE 9T:
Areas controlled by nerves: adrenal and supra-renal glands.
Possible effects of a Malfunction:
allergies
hives
VERTEBRAE 10T:
Areas controlled by nerves: kidneys.
Possible effects of a Malfunction:
kidney trouble
hardening of the arteries
chronic tiredness
nephritis
pyelitis
VERTEBRAE 11T:
Areas controlled by nerves: kidneys, ureters.
Possible effects of a Malfunction:
acne
pimples
eczema
boils
VERTEBRAE 12T:
Areas controlled by nerves: small intestines, inguinal rings.
Possible effects of a Malfunction:
rheumatism
gas pains
sterility
VERTEBRAE 1L:
Areas controlled by nerves: large intestines, inguinal rings.
Possible effects of a Malfunction:
constipation
colitis
dysentery
diarrhea
ruptures
hernias
VERTEBRAE 2L:
Areas controlled by nerves: appendix
abdomen
upper leg.
Possible effects of a Malfunction:
cramps
difficult breathing
acidosis
varicose veins
VERTEBRAE 3L:
Areas controlled by nerves: sex organs
uterus
bladder
knees.
Possible effects of a Malfunction:
bladder troubles
menstrual troubles such as painful or irregular periods
miscarriages
bed wetting
impotency
change of life symptoms
knee pains
VERTEBRAE 4L:
Areas controlled by nerves: prostate gland
muscles of the lower back
sciatic nerve.
Possible effects of a Malfunction:
sciatica
lumbago
difficult, painful or too frequent urination
backaches
VERTEBRAE 5L:
Areas controlled by nerves: lower legs
ankles
feet.
Possible effects of a Malfunction:
poor circulation in the legs
swollen ankles
weak ankles and arches
cold feet
weakness in the legs
leg cramps
SACRUM:
Areas controlled by nerves: hip bones, buttocks.
Possible effects of a Malfunction:
low back pain
spinal curvature
COCCYX:
Areas controlled by nerves: rectum
anus.
Possible effects of a Malfunction:
hermorrhoids(piles)
pruritus (itching)
pain at end of spine on sitting
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