Symptoms of spinal misalignment questionnaire
The nervous system controls and coordinates all organs and structures of the human body.(Gray"s Anatomy, 29th E). 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 circle under the
'Possible Effects' column to indicate your symptoms.
| Areas Controlled by Nerves Directly or indirectly | Possible Effects of a Malfunction | |
| Blood supply to the head, pituitary gland, scalp bones of the face, brain, inner and middle ear, sympathetic nervous system | O headache, O nervousness, O insomnia, O head colds, O high blood pressure, O migraine headaches, O nervous breakdowns, O amnesia, O chronic tiredness, O dizziness | |
| Eyes, optic nerves, auditory nerves, sinus, mastoid bones, tongue forehead | O sinus trouble, O allergies, O crossed eyes, O deafness, O eye trouble, O ear ache, O fainting spells, O vision difficulties | |
| Cheeks, outer ear, face bones teeth, trifacial nerve | O neuralgia, O neuritis, O acne or pimples, O eczema | |
| Nose, lips, mouth, Eustachian tube | O hay fever, O catarrh, hearing loss, O adenoids | |
| Vocal cords, neck glands, pharynx | O laryngitis, O hoarseness, O sore throats, O quinsy | |
| Neck muscles, shoulders, and tonsils | O stiff neck, O pain in upper arm, O tonsillitis, O whooping cough, O croup | |
| Thyroid gland, bursa in the shoulders, elbows | O bursitis, O colds, O thyroid conditions | |
| Arms from elbows down, including the hands, wrists and fingers, esophagus, and trachea | O asthma, O cough, O difficult breathing, O shortness of breath, O pain in lower arm, O pain in hands | |
| Heart, including its valves and covering, coronary arteries | O functional heart conditions, O chest conditions. | |
| Lungs, bronchial tubes, pleura, chest, breast | O bronchitis, O pleurisy, O pneumonia, O congestion, O influenza | |
| Gail bladder, common duct | O gall bladder conditions, O jaundice, O shingles | |
| Livers, solar plexus, blood | O liver conditions, O fevers, O low blood pressure, O anemia poor circulation, O arthritis | |
| Stomach | O stomach trouble, O nervous stomach, O indigestion, O heart burn, O dyspepsia | |
| Pancreas, duodenum | O ulcers, O gastritis | |
| Spleen | O low resistance to colds and disease | |
| Adrenal and supra-reanl glands | O allergies, O hives | |
| Kidneys | O kidney trouble, O hardening of the arteries, O chronic tiredness, O nephritis, O pyelitis | |
| Kidneys and ureters | O acne, O pimples, O eczema, O boils | |
| small intestines, lymph circulation | O rheumatism, O gas pains, O sterility | |
| Large intestines, inguinal rings | O constipation, O colitis, O dysentery, O diarrhea, O ruptures, O hernias | |
| Appendix, abdomen, upper leg | O cramps, O difficult breathing, O acidosis, O varicose veins | |
| Sex organs, uterus, bladder, knees | O bladder trouble, O menstrual trouble such as painful or irregular periods, O miscarriages, O bed wetting, O impotency, O change of life symptoms, O knee pains | |
| Prostrate gland, muscles of the lower back, sciatica nerve | O sciatica, O lumbago, O difficult, O painful or too frequent urination, O backaches | |
| Lower legs, ankles, feet | O poor circulation in legs, O leg cramps, O swollen ankles, O weak ankles and arches cold feet weakness in the legs, O leg cramps | |
| Hip bones, buttocks | O low back pain, O spinal curvature | |
| Rectum, anus | O hemorrhoids, O piles, O pruritus (itching), O pain at end of spine on sitting |
^ back to top ^