A Guide to CBD Dosing: The Correlation Between Dose & Potency
There is an abundance of information available about the daily use of whole plant hemp CBD oil to help maintain and support a healthy lifestyle, however there remains a lack of sound guidance on CBD oil dosing.
The Top 5 Strategies to Manage Your Reputation Online
You don't need an acupuncture website anymore! Okay, maybe that statement is a little over the top. But it's not that far from the truth. A recent study on Google searches revealed that 34 percent of all searches resulted in no clicks at all.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 2)
In cases of cervical spine trauma, particularly trauma related to a motor vehicle accident, my plan is to teach the patient one exercise per session and build a progression. This is an effective approach I call an "activation circuit."
A Soy Isoflavone That Packs a Punch: Genistein
Soybeans contains unique substances called isoflavones, most notably genistein and daidzein, which have been shown to block the buildup the dangerous type of testosterone in the prostate gland linked to prostate enlargement and prostate cancer.
Reaching for Our Roots: Healing Digestion With a Simple Traditional Therapy
Are you ignoring a powerful tool in your doctor's bag? Many acupuncturists realize that Spleen Qi deficiency has reached epidemic proportions in the U.S. Yet, we don't prioritize educating our patients about the importance of warm, cooked foods.
VA Chiropractic Reduces Veterans' Use of Opioids?
Utilization of pain medication – particularly opioids – has been massively high in among veterans for decades, but Veterans Administration guidelines that recommend nonpharmacological first-line treatment options create a greater opportunity than ever for VA chiropractors to make a dent in the opioid and overall pain-management crisis.
Knocking Down the Doors: Big Media Success for F4CP
Three articles authored by a DC or a chiropractic organization and promoting the value of chiropractic care – par for the course if you're Dynamic Chiropractic, but if you're Forbes, BOSS Magazine and Becker's Spine Review, three media outlets tailored toward high-level executives and decision-makers, we're talking about an entirely different story.
Bad for the Back! Exercises That Can Prevent Healing
The questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice.
Reality Check: Do We Need to Try Harder?
While waiting for a flight to a recent chiropractic event, I overheard the ticket agent at the gate next to mine on his cellphone. His side of the conversation went something like this: "Where are you now? How long before you think you can be at the gate? OK, that will work, see you soon."
Map It: Understanding the Customer's Journey
One of the biggest marketing mistakes most practice owners or administrators make is not putting themselves in their prospective or current patients' shoes. How do they think and feel about you and your practice? What makes them take action?
Goodbye, Year of the Dog: Two-Thousand-Eighteen Comes to a Close
As Year of the Dog (2018) comes to a close we can look back and see the progress this profession has made. For example, the International Classification of Diseases (ICD) added traditional medicine codes, which were released in June.
The Raw Food Debate: Practitioners Discuss Nutrition & TCM
Licensed acupuncturist and fellow blogger Elissa Gonda joins this month's column for a conversation about raw food diets. She brings her perspective on the healing potential of a raw primal diet.
Cynicism and Burnout: It Can Happen to You
Trying to achieve fulfillment as a doctor in today's health care environment is a "rigged game" and physicians are programmed to burn out. At least this is the opinion of Dike Drummond, MD, in his thehappymd.com blog.
Malpractice Insurance: Understanding the Cover Letter
Purchasing medical liability insurance is quick, easy and not terribly expensive. The benefits are clearly listed on a certificate—but do you really know what you are getting with that peace of mind?
2018 Gallup-Palmer Report: Key Findings
The fourth annual Gallup – Palmer College report is out; here are some of the key findings excerpted directly from the executive summary regarding Americans' experiences with chiropractic care relative to the management of neck and back pain:
The Truth About Malpractice Claims Against DCs (Pt. 1)
Over the past 20 years of active practice, I have seen a number of scary case scenarios regarding signs, symptoms and patient presentations in my office. These presentations scream, This patient is going through an event or This patient does not need chiropractic care, they need emergency care.
A New President for AOMA: A Conversation With Mary Faria
Dr. Faria was formerly a health care executive for over 30 years, the last 17 of those years as vice president and chief operating officer of Seton Southwest Hospital in Austin. She chairs the board of Austin Mayor's Health and Fitness Council.
Dietary Supplements That Help Restless Leg Syndrome
It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men.
Year in Review: DC's Best of the Best for 2018
As 2018 winds down, let's highlight the most popular articles in Dynamic Chiropractic by month (December – this issue – excluded, of course).
Acupuncture in Hospital Systems: Transitioning From Tolerated to Celebrated
I've had the pleasure of working with Susan Luria, Director of University Hospitals Health Systems Connor Integrative Health Network (CIHN) for the past year on the Integrative Health Policy Consortium (IHPC) Board of Directors and Federal Policy Committee.
VA Choice Claims Denied? Here's How You Can Get Paid
The VA Choice Program (PC3 as well) indeed pays for chiropractic care including manipulation (CMT 98940-98943) and some physical medicine services.
ACA Champions H.R. 7157; ICA Voices Major Concerns
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
Acupuncture is a Science-Based Medicine
A longstanding patient of mine came in for a routine treatment after she recently began seeing a chiropractor for neck pain. She saw him a couple of times and wasn't getting the relief she had hoped for, so he recommended she let him do dry needling.
Electrotherapy Gives Hope for Patients With Spinal Cord Injury
There has been little optimism for recovery from a spinal cord injury because the central nervous system does not repair itself well. The severity of the injury depends on the affected area.
A Simple Miracle: Treatment for Mysterious Foot Pain
Under the old ICD-9 diagnosis codes, there was actually a diagnosis for "adventures in medical mismanagement" to describe patients who had been run down the rabbit hole of poor case management and care. I encountered one of those patients in my office today.
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.