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The Gluteal-Knee Connection
The underlying causes of knee pain and dysfunction are rarely isolated to the knee. The knee is a relatively stable joint with limited intrinsic ability to adapt to aberrant motion.
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Not Another Typical Drug Company Lawsuit
It's becoming more common to see drug manufacturers negotiate "false claims" settlements for millions and billions of dollars.1-2 Most of these settlements have to do with violations in the marketing of the drugs they produce and sell.
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Advice for Young Doctors
When I began practice, I was just shy of my 25th birthday. I was young and I looked it. I had been told this would be a problem when starting a practice – and it was. Older patients often paused when they entered for care.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
Resolving Medial Arch Suspicions: The Navicular Drop Test
Healthy feet have three distinct arches: medial longitudinal, lateral longitudinal and anterior transverse.
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Talking to Skeptical MDs: "Just the Facts, Ma'am"
The first lesson in public speaking is to know your audience. This is particularly applicable when talking to skeptical medical doctors about chiropractic. You have to understand where they are coming from and speak the language they understand.
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
April, 2013, Vol. 13, Issue 04
Reclaiming Functional Feet: The Janda Short Foot Exercise
By Nicole Nelson
The plantar intrinsic foot muscles might be the most underestimated players in the quest for optimizing posture and ideal function. These muscles are instrumental in controlling the dissipation of ground forces and stabilizing the foot during impact.Likewise, afferent inputs from the sole of the foot are believed to affect postural awareness and gait. It stands to reason that improving the function of the intrinsic foot muscles may be one of the best ways to promote ideal stabilization and motor control throughout the entire body. The following is a review of the basics of the intrinsic foot muscles (IFM), the implications of imbalance in the IFM and a discussion of Janda's short foot exercise.
Anatomy and Function
The plantar IFM are arranged in four layers, all of which are innervated by the plantar branches of the tibial nerve. The first layer consists of the abductor hallucis (often celebrated as the captain of the IFM), flexor digitorum brevis and the abductor digiti minimi. The second layer includes the quadratus plantae and the lumbricals; the third layer includes the adductor hallucis transverse, adductor hallucis oblique, flexor hallucis brevis and flexor digiti minimi brevis. The fourth layer includes the interossei muscles. The plantar IFM differ from their more extrinsic foot counterparts in that they strictly span the foot and do not cross the ankle. Their primary function is to provide dynamic support of the medial longitudinal arch (MLA) of the foot and to control forces that act to excessively spread the arch while walking, running or jumping.
The MLA consists of the calcaneus, talus, navicular, cuboid, three cuneiforms and the first three metatarsals. Many conceptualize these bones as fixed; however, there should be a fair amount of rotation, flexion and extension occurring between these structures during impact and push off phases of gait, as this mobility is necessary for additional shock absorption and force generation. While many foot structures contribute to the static and dynamic control of the MLA, the intrinsic foot muscles may be the most important. A study by Fiolkowski et al 2003, discovered a significant navicular drop (the keystone of the MLA) after administering a nerve block in order to de-activate the intrinsic muscles in study participants. Another study by Headlee et al 2008, induced fatigue to the IFM and also discovered a significant navicular drop. Both of these studies indicate the essential role of the IFM in supporting the MLA and suggests that IFM weakness can contribute to an unstable, poorly functioning foot.
IFM Imbalance Implications
Although difficult to isolate the IFM during testing, weakness in these muscles have been associated with many foot and ankle problems including plantar fasciitis, lesser toe deformities and bunions. Weakness of the intrinsic foot muscles is considered a risk factor for plantar ulcerations in individuals suffering from diabetes. This is likely due to the altered foot rollover during gait and ineffective plantar load distribution. Imbalance in these muscles is not simply a local issue, as faulty foot mechanics are known to cause compensations up the kinetic chain leading to knee, hip, low back and cervical issues.
How about just going for a barefoot run to train the IFM? I'm often asked if minimalist footwear or going sans shoes is a good way to correct poorly functioning feet. As Gray Cook would probably say,"don't add strength to dysfunction." The problem I have with our clients ditching their clunky running shoes is that their feet are not prepared for the demands of their body weight meeting the ground without a nice cushioned buffer. It is my opinion that some feet just don't have the potential to go completely naked; those that do will need to improve the function of the intrinsic foot muscles and progressively strengthen the musculature before they begin wearing the minimalist footwear or going barefoot for extended periods of time. In other words, running barefoot or wearing minimalist shoes are the end game, not the place to start. Janda believed that the proprioceptors on the sole of the foot need to be stimulated and a balance of activity among the intrinsic and extrinsic muscles of the foot needs to be established in order for lasting positive change can occur. So our "restore the foot project" should begin with a combination of appropriate soft tissue work and sensory motor retraining and maybe somewhere down the road, our clients can let their feet run naked. As always, consider the entire body when doing your evaluation and assessments.
As much as I like simple assessments, the old "wet foot test" probably doesn't reveal all that much in terms of what we need to do to help our clients reclaim functional feet. Although many would say the SFE is well suited to the flat foot (pes planus), those with high arches (pes cavus) and neutral arches can collapse just as much as the structurally flat foot during dynamic foot movements. Along these same lines, all arch sizes are subject to issues such as plantar fasciitis, achilles tendonopathy, tibialis anterior and posterior overuse syndromes, stress fractures, etc. This has led many researchers and clinicians to suggest that these commonly seen overuse pathologies may be a result of the client lacking the ability to control the arch upon landing and pushing off rather than just having a puny arch. So, if our goal is to improve the ability of these muscles to dynamically control the MLA, we need to see the client's feet in action. I use two dynamic assessments, which are not meant to take the place of a thorough exam by a foot specialist, but it will give you an idea of if the IFM are adequately controlling the MLA.
Walking test. Without the client's knowledge, observe the way they walk toward you (you will get a more accurate impression of their foot control if they don't know you are critically assessing them). A few things you want to look out for:
Single leg test. Have the client stand facing a wall, with the feet and knees shoulder width apart, with the knees slightly flexed. The client should place their finger tips on the wall for a bit of balance help. Instruct the client to gently supinate the feet by lifting their toes (this will wind the plantar fascia and create an arch), then slowly drop the toes but try to maintain the arch that was created. If they can't do this on their own, you can help by placing your hands on their foot and actively shortening their foot for them. While holding the MLA, have the client lift one foot and stand on one leg for 30 sec. Note the steadiness of the client and watch for any reduction in the MLA. Keep a look out for excessive toe grabbing; this is considered faulty patterning and demonstrates a dominance of the more extrinsic muscles of the foot and ankle. Have them perform the same test on the other foot.
If you observed any the faulty patterns mentioned above, the SFE is likely a good corrective exercise for them.
Towel Grab vs. Short Foot Exercise
I admit, I used to love the towel grabbing exercise for my weak footed clients; as it turns out, it may not have been the best IFM strategy. Recent research pitted the towel grab exercise against the SFE with the researchers concluding that the SFE is more effective at recruiting the IFM. Despite these results, don't ditch your towels, just save them for the clients with weak, unstable ankles.
I find the best time to work the SFE into a session is after bodywork. Specifically after I've done some big toe mobilization and myofascial work on the feet. When your clients first attempt the SFE, they will likely have no sense of how to turn on these intrinsic muscles, this will be seen by the client grabbing the ground with the toes. This lack of motor control will require your assistance to model what the foot should do. With your client seated, place one of your hands on the back of the client's heel, while the other hand should cup the forefoot. Gently squeeze the 1st and 5th metatarsals together while creating a supportive pressure to the back of the heel. Your intention is to condense their foot, which should create a neutral arch for them. Ask your client to feel what is happening to their foot and to try and appreciate the energy it would take to hold this foot posture.
With your hands on the client's foot, have them actively hold the arch, assist them with some tactile support when you note a failure of proper foot activation. Cue the client to narrow the forefoot and pull the front of the foot toward the heel. They should be able to create an arch while the toes and heels remain flat on the floor and the toes are not excessively grabbing the floor. Once the client has developed a feel of what the short foot feels like, keep them seated but wean them from your help by taking your hands away and have them hold the short foot for 10 seconds followed by a short rest, then repeat 4-5 times. The next progression is to perform the SFE while standing, once again challenging them to hold the short foot for 10 sec and then resting and repeating 4-5 times.
As these muscles get stronger and more adept at firing, have them hold the short foot for longer intervals. Eventually have the client integrate their new and improved "short foot" to more functional activities such as performing a squat-single leg standing while touching a wall for support (single leg standing without the wall) performing a lunge, etc.
The SFE may be one of the best ways to re-establish control of the intrinsic foot muscles. These muscles are known to have a positive influence on posture and gait, yet are often times "out to lunch" regardless of foot type. Soft tissue work in addition to improving motor control of the foot will go a long way to restoring muscular balance, optimizing posture and preventing injury.
Nicole Nelson a licensed massage therapist in Jacksonville, Fla. She has a masters degree in Health Science from the University of North Florida and is a certified Advanced Health and Fitness Specialist through ACE.
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