Is Primary Spine Care the Answer for Chiropractic?
Recently, we sat down with Mark Studin, DC, FASBE(C), DAAPM, DAAMLP, to discuss the state of chiropractic and why primary spine care may hold the key to chiropractic's future. Read what he had to share in this exclusive interview.
Reducing Allostatic Load & Stress Through Heightened Awareness
Your contemporary mental health and psychotherapy colleagues may often approach the treatment of allostatic load as a mental health condition and use prescription psycho-pharmaceutical medicine to affect general and specific central nervous system (CNS) pathways and brain neuro-chemistry medicine to alleviate the associated symptoms.
It's Time for a Functional Approach to Chronic Illness
It seems one of the more modern buzzwords is chronic, referring to diseases – that is to say, "ongoing and incurable." However, we can take a different perspective and recognize that, although the body may have been traumatized and injured, healing should always be viewed in the realm of possibility.
Diagnosing & Treating Aggressive Energy
Recently, there has been an article, and subsequent discussion, about the subject of Aggressive Energy (AKA "AE"), including ways to detect its presence and an alternative method of treating it.
Old Trend, New Risks: Heavy Weight Training
With more opportunities to exercise than ever, a greater selection of exercise options, and the subsequent opinions supporting and challenging their merits, it's easy to be confused as to which approach is best.
Official NCCAOM Practice Tests
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is excited to announce the launch of the new NCCAOM Exam Preparation Center.
Dropping Insurance: 4 Steps
My office manager just got off the phone with the secretary of a long-standing patient. I have treated this woman and 10 members of her family for more than a decade. She has, as have all of my patients, paid my fee at the time of service since I dropped insurance in 1997.
Chiropractic's Next Frontier: Adjusting the Microbiome
Restoring a healthy microbiome to help treat disease may be the next frontier in chiropractic offices around the country.
Paving the Way to Integrative Health & Wellness
Jared Polis (D-Colorado) and Mike Coffman (R-Colorado) launched the integrative health and wellness (IHW) caucus in October, 2018.
Prevention: Stop Recurrent Urinary Tract Infections
The recurrent urinary tract infection (UTI) is one of those nuisance conditions that can play havoc with quality of life, and this particular infection is much more common than most people realize.
A Novel Way to Prevent Elderly Falls: Toe Strength
In any given year, nearly 40 percent of senior citizens ages 70 and older will fall at least once. Each fall significantly increases the risk of not only sprains, strains and contusions, but also fractures.
New Opportunities for DCs
For decades, the model chiropractic practice has been the single-doctor practice. Recent surveys have found that approximately two-thirds of U.S. doctors of chiropractic still practice this way, with another 20 percent practicing in multiple-chiropractor practices.
The Acupuncturist and the Opioid Crisis: Conquering Pain & Addiction in the U.S.
The current opioid epidemic dominates the discussion among national health leaders, recovery advocates and families nationwide. Opioids include heroin as well as prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.
Spring Allergies & The Spleen: Looking at Pattern Differentiation
As the season of Spring fades away and we shift into the warm summer months, many patients suffer from chronic allergies. This is by far one of the most common issues I see in the clinic as well as often mistreated and misdiagnosed.
News in Brief
Parker University Launches New Open-Access Research Journal for Chiropractic; Western States, Cleveland-KC Name New Deans of Chiropractic Colleges; Sherman College Goes Tobacco-Free; Life University Wins 11 Awards.
Catch the Workplace Wellness Wave
Do you offer workplace wellness services to local businesses? If not, you might want to consider this lucrative channel for expanding your practice. Workplace wellness programs and wellness-related benefits have grown in popularity over the past several decades.
Cyber Threat Checklist: Defend Your Business With These 10 Steps
Living in an internet connected society brings many conveniences and benefits. The power of the internet to connect us with customers, store data, and find information has opened the door for many small business owners to grow and flourish.
Better With Chiropractic
While chiropractic care is receiving high levels of exposure these days, most pain patients who consult with a health provider still do so with their primary-care MD. And of course, that means in most cases, they're receiving standard medical care, not chiropractic.
Practice Pearls: There's More to ROM Than Meets the Eye
As part of my neuromusculoskeletal examination, I perform range-of-motion (ROM) evaluations. I can "eyeball" the range and measure, I can use a goniometer and measure, I can use my phone app and measure, or I can use various other instruments to help determine degrees of motion.
Acupuncture's Standard of Care
Both a concern and critique of acupuncture, frequently espoused by the bio-medical community is, "there is no standard of care in acupuncture." The following is why I believe this statement is disingenuous at best.
First World Spine Care Graduate: Hildah Molate
Hildah Molate, the first World Spine Care (WSC) scholarship student, graduated from Palmer College of Chiropractic earlier this year and is now working at the WSC community spine clinic in Shoshong, Botswana.
Regenerative Medicine: How to Do It by the Books
The "lay of the land" for regenerative therapies, including but certainly not limited to adult stem-cell treatments, seems to change almost daily.
Prompting Memory: How to Stimulate Cognition
Recently I gave a talk titled, The Art of Memoir – Tapping the Past to Sharpen the Present at a senior lunch event in Austin, Texas.
Missed Causes of LBP: It's the Syndrome, Not the Subluxation
When I read the chart notes of other chiropractors, I am usually disappointed. They list what vertebrae are fixated or misaligned. They may describe the involved fascia and muscles.
Bastyr University: On the Front Lines of the Pain Epidemic
At University of Washington's Harborview Medical Center, the Seattle region's only Level I Trauma and Burn Center, the demands for in-patient care are dramatically different from a private clinic environment.
TCM Codes for the World
I just received an email concerning the ICD-TM11 codes. The World Health Organization (WHO) will be presenting the new ICD-11 codes to World Health Assembly very soon.
Multi-Dimensional Acupuncture: 3D, 4D & 5D
Maggie is an intuitive healer and workshop leader who I met on a recent hike. While we were talking she told me how she had to take it easy because of her knees. She said that her doctor told her that she has the early signs of arthritis.
Transforming Exam Delivery
The NBCE Board of Directors has never wavered on its promise to deliver an excellent, on-campus computerized testing experience to students. Likewise, there has never been a compromise to the delivery of fair, valid and legally defensible exams.
NBCE to Reinstitute Computer-Based Exams
The National Board of Chiropractic Examiners (NBCE) has announced it will reinstate computer-based testing in January 2019 courtesy of a partnership with testing and assessment solutions provider Prometric.
Meet the Popliteus: A Cause for Knee Pain
Pop ... what? Meet the popliteus; a behind the scenes player that could be the biggest cause of your knee pain. One of the most common complaints amongst a wide demographic is knee pain. The causes can be as broad as the presentations. From patello-femoral (aka runner's knee), Iliiotibial Band Syndrome, Osgood Schlatter disease, and numerous additional ailments, many a knee pain can often be remedied with soft tissue treatments, corrective exercise prescription, and proper movement pattern re-education if the therapist knows where to begin.
The Whole Picture
Before diving into the treatment side of things, it's important to gain a wholistic picture of how the client moves as well as a static postural screen. Both of these tools can lead to a more successful treatment plan based on real observation of the client in motion and static posturing. At the very least, I recommend Gray Cook's Functional Movement Screen (FMS) as well as his Selective Functional Movement Assessment (SFMA) course.
The knee joint is the largest and most complex joint in the human body. It's also one of the most easily injured. Located in between the ankle joint, the hip joint, and all the muscles that contribute to locomotion, the knee is subject to a number of mechanical forces and factors. While most of us are extremely familiar with the quadriceps, hamstrings, and calf musculature, there is one particularly small muscle that plays a huge role in knee stabilization and it resides behind the scenes. Literally.
The popliteus can be found on the posterior leg and runs from the lateral side of the femur to the medial side of the tibia. It sits behind the knee deep to the superior calf and distal hamstring musculature. It inserts onto the medial, posterior tibial condyle and originates on the lateral femoral condyle on the superior aspect. When treating this area, be mindful of pressure and length of time spent there.
The Importance of Proper Mechanics
When it comes to gait pattern, this little muscle is critical in stabilization and proper mechanics. A tight or weak popliteus can wreak havoc not only on the knee but also in foot and hip function. The popliteus has three basic motions that have critical impact on gait pattern:
It contributes to knee flexion by initiating the motion and unlocking the knee from full extension. If the popliteus is tight or shortened, it has an inhibitory effect on leg extension thus an inability to fully straighten the leg.
When the foot is planted, such as in a walking or running gate, the popliteus laterally rotates the femur at the juncture of the tibia/fibia. During the transition phase of a gate pattern (foot is in the air) the lower leg is medially rotated under the femur readying for the next foot strike. A shortened popliteus in this case would cause excessive pronation and an improper foot placement in landing.
In addition, the popliteus is extremely important when downhill running or walking. In conjunction with the posterior cruciate ligament, it assists decelerating the femur from sliding forward on the tibia due to gravitational forces. Given its deep location and often overlooked contributing role in gait pattern, it isn't typically included in standard treatment approaches to knee pain. However, it should be pretty clear at this point that ignoring this small, discrete player is a bad idea.
Now before you go digging around behind your clients knee like you're looking for the newest prize in the cracker jack box (totally just aged myself with that one), be precise about the placement of your fingers. There are nerves and blood vessels in the popliteal fossa that can become compressed or injured if too much pressure is applied.
It's also vital to determine if the popliteus is where you need to be spending your time. That's when a solid understanding of how to conduct movement assessment is essential as well as some basic detective work. If you already know that your client is an overpronator, that's a decent clue. Take a look at their running shoes or the shoes they wear everyday if you can't quite tell. Looking at the wear patterns on the sole of a shoe can tell you a lot about how someone spends time in their feet.
Locating the Source of Pain
If they're complaining of pain on the medial and/or front of the knee especially when they run, walk up stairs, or downhill, those are also signs that palpating the popliteal fossa is a good idea.
So how do you get your hands on it to treat it? Glad you asked. One of the easiest ways to access this muscle is to have your client lie prone with the leg being treated passively flexed and supported. It can also be accomplished with the client lying supine with the leg passively flexed and their foot on the table. From the lateral side:
From the medial side:
If your client has a history of chronic knee pain or pain that is worsening, the popliteus will likely be very tender. Apply the appropriate soft tissue techniques based on your findings and re-assess your client's perception of pain when performing a simple walking pattern, squatting, running, or any other motion that had previously caused pain.
Subsequent treatment sessions that include manual therapy as well as movement re-education may be in order depending on the clinical presentations. It's important to recognize that just as the popliteus can be the causation for knee pain, it can also create painful symptoms at the ankle and hip due to it's influence on gait.
Considering the Other Mechanics
In addition, the popliteus itself can become painful much like any other tendonosis. If the lateral hamstrings are stronger than the medial hamstrings, this will cause weakness in the popliteus and could lead to its injury or injury of the knee or both. Another contributing factor to stress on this muscle is overpronation at the foot. This often presents as medial knee pain and is confused with meniscus issues.
Assessing and treating knee pain should be an all encompassing and broad view of all potentially contributing factors. Sometimes taking a 10,000 foot view can serve as a faster way to determine the direction of treatment.
As always, avoid diagnosing and refer to the appropriate medical provider for anything not within your scope of practice. The next time you have a client complain of knee pain, let this little behind the scenes muscle "pop" into your clinical lens of speculation.