3 Facts About the Feet

Transcription

1 3 Facts About the Feet 1. The most common subluxation pattern of the foot is EXCESSIVE PRONATION. Nearly all excessive pronation is BILATERAL but ASYMMETRICAL. 2. Most foot subluxations do not create foot SYMPTOMATOLOGY. 3. Whatever one arch in the foot does.so do the other two. 4 Global Postural Distortions Commonly Found Together 1. bilateral/asymmetrical foot pronation 2. pelvic tilt 3. ant. translation of pelvis 4. ant. translation of cervical spine 1

2 The Concept of THE NOISY JOINT TM MECHANORECEPTORS Provide continuous feedback about where the body is in space Position sensitive Motion sensitive Vibration sensitive Pressure sensitive Thermo sensitive Chemo sensitive Inhibit perception of pain Types 1, 2, and 3 mechanoreceptors ADAPT Type 4 mechanoreceptors DO NOT ADAPT What are the nociceptors in your wrist/foot doing right now that they weren t doing when your wrist was in a more neutral position? What is the final destination of the nociceptive impulses, created in your wrist/foot, if they are not inhibited? Excessively Firing Sensory Cortex 2

3 If the nociceptive impulses from your wrist/foot were not inhibited and the impulses elicited an action potential in the sensory cortex, what is the conscious sensation that one would feel called? What inhibits nociceptive impulses? The firing of Type 1,2, and 3 mechanoreceptors Pain Restricted joint motion causes an increase firing in nociceptive axons. and a decrease firing of large diameter mechanoreceptor axons. Where does the inhibition of nociceptors by types 1, 2, and 3 mechanoreceptors occur? Hooshmand H. Chronic pain: reflex sympathetic dystrophy, prevention and management. Boca Raton, FL CRS Press:1993. p At a Level of the Spinal Column How many impulses reach the sensory cortex every second? 3 Trillion How many of the sensory impulses that bombard the sensory cortex every second are conscious impulses? Pain is a conscious sensation. 50 Furman and Gallo, The Neurophysics of Human Behavior. 3

4 Nociceptor activity reflexively activates the sympathetic nervous system..nociceptive input.can cause symptoms such as sweating, palor, nausea, vomitting, abdominal pain, sinus congestions, dyspnea, cardiac palpitations, and chest pain Kabell J. Sympathetically maintained pain.in: Willis W.ed. Hyperalgesia and Allodynia. Raven Press. NY: 1992 Nansel D. Szlazak M. Somatic dysfunction and the phenonema of visceral disease simulation: A probable explanation for the apparent effectiveness of somatic therapy in patients presumes to be suffering from visceral disease. J. Manipulative Physiol Ther 1995:118: Adjustments to decrease nociceptor input to the spinal cord seem to be an effective way to decrease the hyperexcitable central state. Patterson M. The spinal cord: participant in disorder. J Spinal Manip: 1993:9(3) Things Nociceptors Do 1. Initiators of pain 2. Reflexively activate the sympathetic nervous system LIFE IS MOTIONTM Muscles in the Foot The first line of defense of the arches is ligamentous muscles did not come into play until a force greater than 400 pounds was exerted. Basmajian JV et al.the Role of Muscles in Arch Support of the Foot: An Electromyographic Study. J of Bone and Joint Surgery, Vol 45, No 6 September

5 PLASTIC DEFORMATION Low intensity forces for prolonged periods of time create PERMANENT plastic changes Indicators Excessive Pronation 1. Foot Flare / Toe Out 2. Posterior/Lateral Heel Wear 3. Patellar Approximation ( Knock-Kneed ) 4. Achilles Tendon Bowing 5. Dropped Navicular / Flat Arch/ Pes Planus 6. Callouses on Metatarsal Heads 7. Positive Navicular Drop Test (PSI) 8. Non-Grade 5 Psoas, Gluteus Medius, Quadriceps PLANTAR GAIT PATTERNS 5

6 Simple Relationship of Arches-Bones-Muscles Arch Bone Muscle Medial Longitudinal Navicular Psoas Lateral Longitudinal Anterior Transverse Cuboid Metatarsal Heads Gluteus Medius & Minimus Quadriceps Pronation/Stability Index Calculated measurement that reveals individually the severity of pronation for each patient. 6

7 Body Assesment Demonstrates patterns of spinal misalignment Pelvic Assesment Posterior view of pelvic unleveling 7

8 Excessive Pronation Subluxation Pattern BONES Navicular Cuboid Cuneiforms Metatarsal Heads Metatarsal Heads 1 & 5 Talus Calcaneus Fibular Head SUBLUXATION DIRECTION Inferior & Medial *Superior & Lateral (or Inferior & Lateral) Inferior Inferior Superior and Lateral/Medial Mostly Anterior & Slightly Lateral Everted & Plantar Flexed Posterior & Lateral Excessive Pronation Subluxation Pattern (coronal views) Navicular (inferior and medial subluxation) Cuboid (superior and lateral subluxation) Cuneiforms (inferior subluxation) 8

9 Met Heads Talus (anterior and lateral subluxation) (inferior subluxation) Calcaneus (plantar flexed everted) Fibular Head (posterior lateral) ASSOCIATED ADJUSTMENTS DO NOT! 9

10 Heel Spur Adjustment Interphalangeal Adjustment Excessive Supination Subluxation Pattern BONES Navicular Cuboid Cuneiforms Metatarsal Heads Metatarsal Heads 1 & 5 Talus Calcaneus Fibular Head SUBLUXATION DIRECTION Superior & Lateral Superior & Lateral Superior Superior Inferior and Lateral/Medial Slightly Anterior & Mostly Lateral Inverted & Dorsiflexed Posterior & Lateral Supination Pattern Shortcut: 1. Mobilize foot 2. Cuboid The Knee 3. Fibular Head 10

11 5 Important Points/Rules 1. Apply the proper pressures. a. Pressure Hand kg (non-dominant hand) b. Speed Hand 5 kg (dominant hand) Total kg minimum 2. Do not torque. 3. Do not rebound. 4. Apply pressure evenly from thumb to the little finger on pressure hand. 5. The elbows ARE NOT involved Put #14 fingertip on thumb of non-dominant hand Proximal phalanges and thumb pad make single flat surface Pressure Hand Speed Hand On Dominant hand, cross thumbpad over DIP of index finger Thumb pad on contact point Even pressure over entire area Pressure Hand 11

12 Thumb points toward doctor Speed thumbpad on pressure thumbnail Speed Hand Roll speed thumbnail toward pressure hand Pressure hand applies lbs. of pressure Speed hand applies 8-10 lbs. Pressure Set-Up Place knee on table so lateral thigh is parallel to forearm of speed hand Thrust Apply appropriate pressures with hands and extend wrist as quickly as possible Stop the thrust abruptly by stiking forearm against lateral thigh Knee Indicators Medial Condyle 10% 12

13 Lateral Condyle 45% Posterior Tibia 45% Contact Points Upper middle portion of condyle Medial condyle medial listing Lateral condyle Lateral listing Rehab Medial Condlye Vastus Lateralis Point toes medially Extend knee Both condlyes En mass listing Rehab Lateral Condlye Vastus Medialis Point toes lateraly Extend knee Patella Alta 13

14 Posterior Tibia (alternate technique) The Hip 14

15 Carpal/Wrist Subluxation Pattern Typical Carpal/Wrist Subluxation Pattern Scaphoid Triquetrum Lunate Thumb (Carpal- Metacarpal) Radius Ulna Posterior & Medial Posterior & Lateral Anterior Lateral Radius Lateral Ulnar-Medial Proximal Row of Carpals Superior Indicator (anterior depression of the lunate) Scaphoid For Scaphoid and Triquetrum 1. Traction (inferior) 2. Extend to Tension (no more than 30 degrees) 3. Thrust P to A (without winding up or recoiling) 15

16 Triquetrum Lunate For Lunate Radius and Ulna Traction and Squeeze 1. Traction (inferior) 2. Flex to Tension (no more than 40 degrees) 3. Pull A to P (without flexing the wrist) Carpal-Metacarpal Scoop Lat. to Med. Carpal Spread 16

17 Distal Row Distraction The Elbow 17

18 LEFT ELBOW PATTERN 18

19 Shoulder Subluxation Pattern Glenohumeral Joint Acromioclavicular Joint Sternoclavicular Joint Scapulothoracic Joint First Rib Humeral Head Anterior Distal Clavicle Superior Proximal Clavicle Anterior and Medial Fixation/Hypomobile Anterior 19

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22 LEFT SHOULDER PATTERN 22

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26 TMJ Stretch Posterior Cervical Muscles from Superior to Inferior Bilaterally Stretch SCM Muscles Bilaterally 26

27 Stretch Platysma Muscles Bilaterally Neutralise Trigger Points on Temporalis, Masseter, and Buccinator Muscles Bilaterally 27

28 Apply Finger Cot To Index Finger 28

29 Roll Right Lateral Pterygoid Counterclockwise 3 Times Roll Left Lateral Pterygoid Clockwise 3 Times Apply Finger Cots to Both Thumbs 29

30 Assistant Stabilises Patient s Head and Doctor Checks for Side of Laterality Pull Inferior Anteriorand Opposite Side of Laterality, Then Perform Figure 8 Motions Patient Holds Bottom Teeth in Front of Top Teeth and Doctor Strokes TMF Superior to Inferior- Then Patient Relaxes Jaw. Exercise: Patient Translates Lower Jaw Anterior Against Resistance of Thumb. 30

31 Ribs Rib Head Subluxates Anterior From TVP Palpate For Anteriority. Take Tissue Pull from Medial to Lateral so Thenar is Over TVP. 31

32 Thrust A-P Toward Thenar. Another Rib Subluxation. Subluxation is an Overlap of Rib/Cartilage. Pull Rib/Cartilage Apart Several Times on Inhalation. 32

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