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Case Study


High Heels Involved with Postural Stress Conditions
Case Study
Written by John Danchik, D.C., F.I.C.C., F.A.C.C.   
Wednesday, 29 August 2012 22:30
History and Presenting Symptoms
A
 47-year-old female presents with recurrent, sharp pain in her low back. These episodes, which usually resolve within a few days, concern her because they are becoming more frequent. Using a Visual Analog Scale, she describes the usual pain level in her lower back as around 40mm. She doesn’t recall any injury to her back, and cannot identify any specific cause for her pain. She states that she just “tries to relax” for a few days, until the pain resolves.
 
highheelsExam Findings 
Vitals. This patient is 5’6’’ tall and she weighs 136 lbs, which is a BMI of 21.9; she is not overweight. Her blood pressure is 124/76 mmHg, with a pulse rate of 76 bpm. She reports that she has never used tobacco products, and averages 2-3 glasses of white wine per week.

Postural examination. Standing postural evaluation finds basically good alignment throughout her pelvis and spine, except for an accentuated lumbar lordosis. She has a mild bilateral knee valgus and moderate calcaneal eversion, with hyperpronation bilaterally.  During gait, both feet demonstrate a tendency to toe-out. An examination of her shoes reveals scuffing and wearing of the lateral aspect of both heels. She states that she usually wears shoes with higher heels for work, and that she has noticed that all her shoes wear out quickly.

Chiropractic evaluation. Kemp’s testing produces sharp pain localized to the lumbar spine when performed to both sides.  Motion palpation identifies functional limitations in extension at the L3/L4 and L4/L5 levels, with moderate tenderness and loss of endrange mobility. Neurological tests are negative for nerve root impingement.
 
Imaging
A-P and lateral lumbopelvic x-rays in the upright position are taken during relaxed standing.The sacral base angle is 48° and the lumbar lordosis measures 62°, and the lumbar gravity line (from L3) falls anterior to the sacrum.  There is evidence of chronic facet imbrication, with sclerosis seen at L3/L4 and L4/L5. There is no discrepancy in femur head or iliac crest heights, and no lateral listing or lateral curvature is noted.
 
Clinical Impression
Chronic facet syndrome with lumbar hyperlordosis and increased sacral base angle. This postural stress is being exacerbated by regularly wearing high heels, and by her tendency to overpronate during gait.
 
Treatment Plan 
Adjustments. Flexion distraction and side posture adjustments for the lower lumbar region were provided as needed, with good response.

Stabilization. Individually designed stabilizing orthotics were supplied, and she was told to limit her heel height to 1” maximum. She was found to be wearing shoes that were too small for her feet, and was instructed to increase one full size for proper fit.

Rehabilitation. She was instructed in a daily core strengthening program, to be done at home using elastic exercise tubing.The focus was on activation of her transverse abdominis musculature, for improved spinal stability.
 
Response to Care
This patient responded rapidly to her spinal adjustments. She had very little difficulty in adapting to the flexible orthotics, and she reported that the slightly larger shoes with lower heels were much more comfortable. She was consistent with her home exercise program, as demonstrated by her exercise log.  After six weeks of adjustments (eight visits) and daily home exercises, including wearing the orthotics in properly fitted shoes with lower heels, she was released to a self-directed home stretching program. 
 
Discussion
This woman’s case reinforces the importance of investigating all sources of underlying biomechanical stress, especially when a spinal condition is chronic or recurrent.  Shoe-related postural problems are not uncommon, especially in women. Many women don’t check their shoe size for many years, and they often wear shoes th at are too small for their feet.  Heel height can complicate spinal facet syndromes, resulting in a poor response to chiropractic care.
 
Dr. John J. Danchik, the seventh inductee to the ACA Sports Hall of Fame, is a clinical professor at Tufts University Medical School and formerly chaired the U.S. Olympic Committee’s Chiropractic Selection Program. Dr. Danchik lectures on current trends in sports chiropractic and rehabilitation.
 
The Prevalence Of Suboptimal Vitamin D Status In A Randomly Selected Cohort Of Colorado Firefighters
Case Study
Written by Gerard Guillory, M.D. and Michael Mutzel, M.Sc.   
Wednesday, 29 February 2012 12:18

Abstract:

bluesky

V
itamin D insufficiency has been associated with increased risk of CVD, various cancers, autoimmune disease and type 2 diabetes. Despite adequate sun exposure, individuals inhabiting metropolitan areas display a high prevalence of vitamin D insufficiency as determined by serum levels of 25(OH) vitamin D less than 32 ng/mL. The purpose of this study was twofold: 1) to assess the serum levels of 25(OH) vitamin D and prevalence of vitamin D deficiency in a cohort of 20 firefighters that work and reside in the Denver metro region and 2) to perform follow-up lab work after eight weeks supplementation with a microemulsified liquid vitamin D-3 preparation. The initial baseline blood levels of 25(OH) vitamin D were assessed and the study subjects were advised to take 4,000 IU/daily (2 drops) of the vitamin D-3 preparation for eight weeks. After the eight week supplemental period serum levels were retested to establish the percent increase in the 25(OH) vitamin D blood levels. The average initial 25(OH) vitamin D blood level and eight week post test blood levels was 27.02 ng/mL and 54.01 ng/mL respectively. Pretest 75% of the study subjects were defined as deficient (below 32 ng/mL) and only 25% were deficient after 8 weeks of supplementation with the liquid emulsified vitamin D-3.  The average percent increase in serum 25(OH) vitamin D levels was 106%.

Conclusion: Suboptimal vitamin D status is prevalent in Denver firefighters and 8 weeks of 4,000 IU/daily supplementation with a microemulsified liquid vitamin D-3 preparation increased blood levels on average 106%.

Introduction

table1vitaminDVitamin D deficiency is a serious medical condition that has been associated with an increased risk of developing cardiovascular disease, type 2 diabetes, hypertension, various cancers and autoimmune diseases. Vitamin D insufficiency occurs at epidemic levels in many industrialized countries, where exposure to sunlight tends to be limited and diets tend not to include sufficient amounts of foods naturally rich in vitamin D. During 2009, Dr. Guillory tested more than 1,200 of his patients and found that roughly 90 percent had sub-optimal vitamin D levels, as determined by serum 25(OH) vitamin D levels below 32 ng/mL.  Dr. Guillory achieved great success in treating this with Bio-D- Mulsion Forte®, a microemulsified preparation made by Biotics Research Corporation.

The purpose of this study was twofold; firstly to increase public and physician awareness of the scope and seriousness of vitamin D deficiency and secondly to assess the effectiveness of the microemulsified vitamin D preparation. Several preparations have been recommended to patients by physicians for the treatment of vitamin D insufficiency. The availability of vitamin D preparations ranges from high potency tablets and capsules to liquid forms. Vitamin D is a fat soluble hormone and thus requires biliary secretions to properly saponify the fats for proper intestinal absorption. To maximize the efficacy and bioavailability of fat soluble nutrients, enhanced delivery methods have been developed. One such method is an oil in water microemulsification, a closely-held process that enables a fat soluble (water-insoluble) vitamin to be placed into a uniformly micrometer-sized, fat-soluble particle that is dispersible in water and capable of intestinal transport independent of bile acid-saponification. The aim was to ascertain how efficacious 2 drops, yielding 4,000 IU of microemulsified vitamin D-3, would be in raising low serum levels of 25(OH) vitamin D in a group of 20 firefighters residing in the Denver metro area.

Materials and Methods

figure1vitaminD20 full-time firefighters of the Aurora Fire Department were selected on a volunteer basis to participate in an eight-week study during the winter/spring months of 2009. Upon initiation of the study, the 20 subjects were advised to stop consuming multivitamins, cod liver oil and other supplements containing vitamin D. The subjects filled out a medical symptom questionnaire aimed to assess subjective indications of mood, energy level and digestive complaints. All subjects had blood drawn (at the Care Group, PC, office of Gerard Guillory MD in Aurora, Colorado ) and serum levels of 25- hydroxyvitamin D (25(OH)) vitamin D tested through Laboratory Corporation of America (Lab. Corp) via an assay developed by DiaSorin. The subjects were advised to take 4,000 IU/day (2 drops) daily of the liquid emulsified preparation produced by Biotics Research Corporation. After eight weeks of daily supplementation the study subjects 25(OH) vitamin D levels were retested by Laboratory Corporation of America. The subjects also filled out the same medical symptom questionnaire and the data was compiled.

Results

figure2vitaminDAt the beginning of the study, the average baseline 25(OH) vitamin D blood level was 27.02 ng/mL. Current medical guidelines suggest that vitamin D insufficiency begins when blood levels are below 32 ng/mL and optimal disease prevention occurs when blood levels are above 60 ng/mL (REF). Only five study subjects had serum levels above the 32 ng/mL level and two subjects had blood levels less than 11 ng/mL. The majority of subjects had levels in the low to mid 20s (See Table 1). Prior to supplementation 75% of the subjects were deficient in vitamin D and 10% of the subjects were severely deficient (as defined by blood levels below 10 ng/mL).

After the eight week supplemental period the average 25(OH) vitamin D blood level was 54 ng/mL, a 106% average increase. Post supplementation 15 study subjects, or 75%, had serum levels above the deficiency blood level of 32 ng/mL (pre-supplementation 75% were deficient). Only 5 study subjects, or 25%, had serum levels below the 32 ng/mL level. Seven subjects had blood levels above 50 ng/mL, the highest being 114 ng/mL (See Table 1).

Discussionfigure3vitaminD

The prevalence of vitamin D insufficiency in a group of 20 firefighters not taking any vitamin D supplements was found to be 75%. Studies show that individuals with vitamin D levels below 32 ng/mL have an increased risk for developing heart disease, cancers, and autoimmune diseases. Due to high prevalence of vitamin D insufficiency in firefighters residing in a sunny part of the country, physicians should increase their 25(OH) vitamin D blood testing on a more routine basis among firefighters and lay people alike. Increased screening would likely have a huge health and financial impact, leading to increased work productivity and decreased medical costs through disease prevention.

The form of vitamin D supplementation in deficient individuals should be inexpensive, highly bio-available and easy to use for optimal compliance. In this study the microemulsified Bio-D-Mulsion Forte® from Biotics Research Corporation was used and can be attributable to an average increase of 106% in blood levels of the study subjects. It’s likely that the microemulsification process in a liquid delivery form facilitates maximal absorption and bio-availability of the vitamin D supplement. This is evidenced by the consistent increases in blood levels after eight weeks of 4,000 IU/daily use, bringing 75% of the study subjects out of the deficiency reference range.

 
Heel Pain in a Money Advisor
Case Study
Written by John Danchik, D.C., F.I.C.C., F.A.C.C.   
Saturday, 17 December 2011 22:26
heelpainHistory and Presenting Symptoms
The patient is a 55-year-old male, who reports severe pain on the bottom of his left foot when he gets out of bed in the morning.  He also notices pain under his left heel whenever he stands for thirty minutes or more.  Over-the-counter pain medications provide some temporary relief, but his condition does not seem to be improving, even though he has been avoiding extensive walking and standing.  He has been unable to work out at his local gym for the past sixty days, due to heel pain.  There is no history of prior injury to his left foot or ankle. 
 
Exam Findings
Vitals.  This 5’10’’ financial analyst weighs 196 lbs, which means that he is overweight (BMI of 28).  He demonstrates a thickened waist (44 in.), confirming that his excess weight is due to abdominal fat deposition.  He has never smoked, and his blood pressure and pulse rate are within normal range, probably because of his regular involvement in physical exercise (gym activities).
 
Posture and gait.  Standing postural evaluation finds generally good alignment, but a decreased lumbar lordosis.  He has bilateral pes planus (flat foot), with no medial arches and bilateral calcaneal eversion.  These findings are somewhat more pronounced on the left side.  Both feet tend to toe out during walking.
 
Chiropractic evaluation.  The patient’s lumbar spine is moderately tender throughout, and he demonstrates a generalized loss of vertebral mobility, with few specific fixations.  Orthopedic and neurological provocative testing of the spine and pelvis is negative.
 
Primary complaint.  Examination of the left foot reveals exquisite tenderness to palpation over the antero-medial aspect of the calcaneus.  All ranges of motion for the left foot are full and pain-free, and manual muscle testing finds no evidence of weakness when compared to the right side.
 
Imaging
A lateral x-ray of the left foot demonstrates a small bony outgrowth from the anterior aspect of the calcaneus.
 
Clinical Impression
Chronic irritation at the insertion point of the plantar fascia into the calcaneus, with radiographic evidence of a heel spur.  This irritation is apparently secondary to long-standing biomechanical stress associated with poor foot function, and excessive loading from strenuous exercise activity and too much body weight.
 
Treatment Plan
Adjustments.  Mobilization and adjustments were provided to the lumbopelvic region.  The left calcaneus was adjusted anteriorly and both navicular bones were adjusted superiorly.

SYMPTOMATIC HEEL SPURS ARE CHALLENGING CASE PRESENTATIONS, AND THEY REQUIRE APPROPRIATE PATIENT EDUCATION.

 
Stabilization.  Individually designed stabilizing orthotics with shock-absorbing materials were provided to support his arches and to reduce calcaneal eversion.  In addition, a calcaneal “divot” was ordered for the area under the left heel, in order to decrease the pressure on the bone spur.
 
Rehabilitation.  A series of foot exercises was recommended to the patient, to improve the coordination and strength of his foot intrinsic muscles.  After receiving his orthotics, he also performed standing Achilles tendon stretches, keeping his feet in forward alignment.
 
Response to Care
At first this patient’s heel pain was somewhat slow in responding. However, he was diligent with his exercises, and was eventually able to walk in the morning with no foot pain.  At that point, he was advised to return to his regular exercise program at the gym, and he had no further heel pain.  He was released to a self-directed home stretching program after a total of eight visits over six weeks.
 
Discussion
Radiographic evidence of a heel spur does not always correlate with heel pain.  However, it frequently indicates chronic biomechanical stress to the insertion of the plantar fascia.  Symptomatic heel spurs are challenging case presentations, and they require appropriate patient education.

If this overweight 55-year-old man had been less active, or if he had inherited feet with better arches, he would have been less susceptible to heel pain.  However, if he is able to follow through on his decision to drop 22 – 25 pounds of abdominal adipose tissue (which is necessary for him to be considered in the normal weight range for his height), he will be less likely to suffer future recurrences.
 

 
Upper Leg Pain in a Soccer Player
Case Study
Written by John Danchik, D.C., F.I.C.C., F.A.C.C.   
Monday, 03 October 2011 15:40

soccerplayerlegpainHistory and Presenting Symptoms

The patient is a 15-year-old female soccer player, who reports frequent pain for the past several months in her left hip and posterior thigh region.  The pain is most noticeable the day following a highly physical soccer competition or scrimmage, when she experiences tightness and tension in the back of her upper left thigh.  She denies any specific injury, but admits that she has been playing especially hard since getting caught up in the excitement of following the U.S. team in the 2011 FIFA Women’s World Cup this past summer.  She finds that lying down and putting warm towels around her hip helps the most. 

Exam Findings

Vitals.  This athletic girl weighs 129 lbs, which at 5’6’’ results in a BMI of 21 – she is very active and fit.  She is a non-smoker, and her blood pressure and pulse rate are well within the normal range.

Posture and gait.  Standing postural evaluation finds generally good alignment, with intact spinal curves and no evidence of scoliosis.  Closer inspection identifies a higher right iliac crest, mild bilateral knee valgus, and static pronation of the left foot (calcaneal eversion with low medial arch).  Brody’s navicular drop test finds 6mm of excursion of the left navicular prominence between sitting and standing, compared to 3mm of drop on the right.  Gait screening is negative for limp or noticeable asymmetry.

Chiropractic evaluation.  Motion palpation identifies a left sacroiliac fixation, with moderate tenderness and loss of endrange mobility.  Straight leg raise is limited to 78° on the left by pain at the hamstring origin.

Primary complaint.  The left hamstring is weaker than the right on manual muscle testing, and palpation finds tenderness at the left ischial tuberosity and slightly increased tension in the proximal hamstring muscle.  All knee and ankle ranges of motion are full and pain free.

Imaging

Standing AP lumbopelvic view shows a leg length discrepancy, with the left femur head 5mm lower.  Frog-leg views of both hips are negative for ischemic necrosis (Legg-Calve-Perthes) and slipped femoral capital epiphysis.

Clinical Impression

Chronic hamstring strain, with leg length discrepancy (left short leg) and asymmetric foot pronation.

Treatment

Adjustments.  Adjustments of the left SI joint and left foot and ankle were provided as needed.  The adjustments were supplemented by contract-relax stretches for the left hamstring muscle.

Stabilization.  Individually designed, stabilizing orthotics were fitted into her soccer shoes, and another pair was provided for daily wear.  Both were custom made for her postural needs.

Rehabilitation.  Daily strengthening exercises for the left hamstring were gradually progressed from light to strenuous resistance using elastic exercise tubing in a standing position.

Response to Care

This focused young athlete responded rapidly to the adjustments and strengthening exercises.  She adapted to the individually designed stabilizing orthotics with little difficulty, and reported that her ankles and knees felt more secure when on the field.  Within two-and-a-half weeks of receiving the orthotics, she had no post-exercise pain or tenderness.  She was released to a self-directed home stretching program after a total of eight visits over six weeks.

Knee, upper leg and hip pains in a young person with a still-maturing skeleton always raise concerns of ischemic necrosis.

Discussion

Knee, upper leg and hip pains in a young person with a still-maturing skeleton always raise concerns of ischemic necrosis (Legg-Calve-Perthes) and slipped femoral capital epiphysis.  This teenaged athlete had no x-ray evidence of either condition, but did have a biomechanical asymmetry in the lower extremities, which caused a functional short leg.  Appropriate, focused treatment consisting of adjustments and stabilizing orthotics, along with stretching and strengthening exercises, brought about a rapid response.

This patient found wearing individually designed stabilizing orthotics in her soccer shoes to be effective in helping reduce her hip symptoms and enhancing her athletic performance.  Studies have found a significant decrease in electromyographic activity of the hamstring muscles during running while wearing orthotics.  This is thought to be due to the increased stability of the ankles and knee joints, which allows greater relaxation of the hamstrings during gait, especially when running.

 
Post Disc Herniation Surgery Rehab: A Case Study Using Trigenics® Applied Functional Neurology®
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Case Study
Written by Ted L. Forcum, DC, DACBSP, FICC, CSCS, RTP   
Sunday, 25 September 2011 19:17

History in Chief Complaint

Patient DH entered our office with a 45-year history of lower back pain.   2 Years prior, the patient travelled to Germany and underwent a lumbar spine operation, whereby he had artificial disks surgically implanted at L3, L4, and L5.  The procedure was highly successful at decreasing pain and increasing ambulation.  In June of 2004, the patient was seen for difficulties with balance and proprioception secondary to a marked scoliosis related to spasmotic antalgia.  On his initial visit the patient related that there was some post-surgical improvement in balance, and a reduction in the angle of his scoliosis. However, he was now experiencing intractable pain, 8 on a scale of 0 to 10 with 10 being unbearable pain, in the left lateral ankle region, inferior to the lateral malleolus.  The pain had started 2 days prior to his initial visit.  The patient related that the pain increased upon eversion of the foot, and was felt when walking and standing.  His foot was in constant inversion with the first ray off the floor.  The patient had no prior history of foot or ankle ailments.

Examination

There was obvious swelling to the lateral ankle without erythema.  Left ankle plantar flexion was limited at 25/85  degrees (normal active range of motion for plantar flexion is 50 degrees).  Left ankle dorsiflexion was also limited at 5/15 degrees (normal is 20).  Mid Tarsal joints were slightly rigid in motion bilaterally.  Hallux dorsiflexion was normal bilaterally.  The first ray had normal range of motion in a neutral bias and position.  The dorsal pedal pulse was normal bilaterally; however, the tibialis pulse was absent bilaterally. When standing, the patient demonstrated a posture with first ray dorsi flexion whereby the first ray was elevated at proximally 1 cm off the floor.  There was dorsiflexion of the first through fifth metatarsophalangeal joints bilaterally.  Muscle testing of the tibialis anterior extensor pollicis longus was graded 5/5.  Muscle testing of the fibularis (peroneus) brevis and fibularis longus demonstrated 3+ strength on the left.  The eversion stress test was positive and produced pain in the ankle.  The inversion and side-to-side tests were negative.  Patient DH demonstrated moderate tenderness throughout the lateral compartment.  There was pinpoint tenderness at the anterior talofibular ligament with exquisite pain at the calcaneal fibular ligament.  The patient’s left shoe demonstrated disproportionately marked wear on the sole at the lateral aspect of the heel and forefoot. 

Diagnosis

postdhsurgeryBased on the examination it was apparent that patient DH had S1 inhibition, which was being expressed by a marked fibularis longus and brevis weakness.  Patient DH was compensating for this by distributing more weight on the anterior talofibular ligament and calcaneofibular ligament to check ankle inversion.  As such, there was no antagonist control of the stirrup effect created by the tibialis anterior and the fibularis longus. Without this being controlled the tibialis anterior, along with the extensor hallux longus, were overly dorsiflexing the first ray in relationship to the foot upon stance.  The excessive lateral wear pattern on the patient’s shoe was associated with a lack of antagonist control of the deep posterior compartment maintaining the foot in an inverted position throughout the gait cycle and stance.

It was hypothesized that this effect could be the result of a marked aberrant gait pattern.  Prior to the disc replacement surgery, the patient was required to ambulate via crutches or a walker.  There may also be nerve root inflammation due to the surgical procedure.  Peripheral entrapment of the fibular nerve can also occur at the proximal fibular head.  This condition could also be maintained by a supinated gait pattern at the fibular musculature which is activated during the gait cycle.  In this case, the fibularis longus may entrap the common fibular nerve at the proximal fibular head.  However, usually symptomatology and pain in the distribution of the nerve into the lower leg, foot and ankle would precede localized compartmental weakness.

Diagnosis was that of S1 neural inhibition causing fibularis longus and brevis weakness with aberrant biomechanics and pain.

Treatment

Initial treatment consisted of functional application of Trigenics multimodal treatment procedures, incorporating resistive exercise neurology, mechanoreceptor manipulation and cerebropulmonary biofeedback. With Trigenics, the patient is essentially performing concentrative breathing with resisted load exercise movements while simultaneous treatment is applied to the muscle mechanoreceptors to create a cumulative afferent spinocerebellar overload. Correction of sensorimotor dysfunction is targeted by applying neuro-stimulative soft tissue treatment while the patient performs proprioceptive resisted exercises.* According to Dr. Frederick Carrick, “Trigenics is consistent with the principles of neuroplasticity and corticoneural reorganization of the sensorimotor and somatosensory systems.”

Trigenics was applied to the lateral compartment of the left lower leg.  A Trigenics myoneural strengthening procedure was performed and involved physical mechanoreceptor distortion at various points throughout the lateral compartment along with resisted antagonist manual muscle contraction at approximately 20% effort.  Concomitantly, this procedure utilized a pressurized concentrative abdominal breathing maneuver for additional neural input by way of global parasympathetic response. As a result of the application of Trigenics myoneural procedures as noted, there was an immediate, significant increase in muscle strength which improved to 4+/5.  Localized inflammation of the anterior talofibular and calcaneal fibular ligaments were treated with 1.0 W/m squared 20% pulsed ultrasound for 4 minutes and interferential with ice at 10 to 100 Hz for 10 minutes.  Post Trigenics kinetic taping was applied along the course of the fibularis longus in a facilitative pattern with tape applied at approximately 50 to 75% tension with the ankle and foot inverted and dorsiflexed.

Upon examination 5 days post treatment, the pain had reduced to a one on a scale of 0 to 10, and the frequency of the pain had reduced from constant to infrequent.  Muscle strength testing of the lateral compartment demonstrated 5-/5.  However, there was still 2-/3, moderate, pinpoint tenderness over the calcaneal fibular ligament, whereas the anterior talofibular ligament was negative.

This case demonstrated the marked effectiveness of using the multimodal Trigenics® Applied Functional Neurology® procedures in concert with kinetic facilitative taping in the treatment of pre- or post-surgical disc herniation and neuromusculoskeletal conditions or pain syndromes.

*Historically Trigenics is cited by its founder, Dr. Allan Oolo Austin, to be the first treatment of its kind to use a multimodal cumulative neural stimulation approach for enhanced outcome by combining soft tissue manipulation techniques with resisted exercise movements.

 

Dr. Ted Forcum is a Diplomate of the American Chiropractic Board of Sports Physicians (DACBSP). He is also a member of the ACA Council on Sports and Physical Fitness, the United States Sports Chiropractic Federation and the National Strength and Conditioning Association. Dr. Forcum is certified in KinesioTaping (CKTP), Graston Technique, NASM Certified Exercise Specialist (CES), NASM Performance Exercise Specialist (PES), and is a Registered Trigenics Practitioner (RTP). The American Chiropractic Association Council on Sports and Physical Fitness voted Dr. Forcum the 1994-95 & 2004 Sports Chiropractor of the Year and he was also awarded the 2000 ACA Sports Council Achievement Award. Dr. Forcum has worked as an event physician for such events as the Winter Olympics, U.S. Olympic Trials, U.S. Track and Field Championships and the NCAA National Championships as well as many others. Dr. Forcum has also worked extensively as a staff chiropractor for the PGA Tour.  In 2004, Dr. Forcum was voted in as the 2nd Vice President of the American Chiropractic Association Council on Sports and Physical Fitness. He has taught postdoctoral programs for Southern California Health Sciences University, Western States Chiropractic College, Logan Chiropractic College and Northwestern Health Sciences University. He is currently on the teaching faculty of FAKTR-PM and lectures nationally and internationally on the topics of sports injuries and biomechanics.

 
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