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Rehabilitation
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Rehabilitation
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Written by Dr. Kirk A. Lee, D.C., C.C.S.P.
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Friday, 28 March 2008 15:10 |
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Foot position and alignment are important factors that must be considered in our active population. As we encourage more of our patients to walk, jog, and exercise, we need to be prepared for the "side effects" of our recommendations if any foot problems exist.
For example, a 1998 study of runners found that those who pronated more while running had a much greater likelihood of developing a sport-related injury.1 While this isn’t surprising to most of us who have been treating athletes, it helps us to explain why custom-made, stabilizing orthotics can be so helpful in preventing athletic injuries.
This retrospective study looked back at the characteristics of athletes who reported recent foot and leg overuse problems and compared them with a control group. The researchers were interested in finding whether excessive pronation (using a method of measuring pronation while weightbearing) correlated with the possibility of developing various types of "overload" sports injuries.
Overuse/Overload Injuries
The clinical conditions evaluated in this study are known as "overuse," or "overload" injuries. These injuries develop when the body is unable to strengthen and rebuild in response to strenuous and repetitive athletic or work activities. In this study, sixty-six injured athletes who ran at least once a week—and who had no history of traumatic or metabolic factors to their overuse injury—were the study group. Another (control) group of 216 athletes were matched who had no symptoms of overuse injuries.
The amount of pronation during standing and while running at "regular speed" was determined by measuring the angles of their footprints. This inexpensive method of determining the amount of pronation during functional activities (plantar prints) had been previously investigated.2 One of the advantages of this method of measuring pronation is that it can be done without X-rays (no radiation exposure) and is not time consuming.
The investigators found that athletes with more pronation had a much greater likelihood of having sustained an overuse athletic injury. They also established that the amount of pronation seen in the standing, weightbearing footprint was the more predictive of developing an overuse injury. This study reminds us that it is very important to athletic performance and for injury prevention to check the alignment of patients’ feet in the standing position.
Knee Pain Study
The researchers in another study performed a visual assessment of the feet of seventy-seven athletes while they were standing.3 After classifying the feet as obviously pronated, obviously supinated, or neutral (based on agreed-upon mandatory criteria), the investigators inquired into the history of knee pain. Those athletes who answered "yes" to the question of knee pain were more than twice as likely to have an abnormal foot alignment. This study found that "athletes with excessively pronated or supinated foot types may be more susceptible to knee pain than athletes with neutral foot types." Since knee injuries can often ruin athletic aspirations, controlling pronation and absorbing the shock of supination could be crucial for many athletic patients.
Anticipating ACL Injuries
Some knee injuries seem so sudden and unpredictable that prevention would appear to be impossible. This may not actually be the case with many acute injuries to the anterior cruciate ligament (ACL). An important study looked at pronation in athletes and found a higher risk of injury to the ACL in those with hyperpronation.4 These researchers looked at the amount of arch collapse to determine the tendency to excessive pronation. They used the "navicular drop test," which is another easy method to assess a patient’s foot and can be done quickly in the office. "Postural Stability Indicator" (PSI) cards—which explain how to do the test and also record your findings—are available free, just by dialing 1-800-553-4860.
When the researchers compared fifty subjects who had sustained an arthroscopically diagnosed rupture of their ACL with fifty uninjured matched controls, they found that higher scores on the navicular drop test correlated with a history of ACL injury. Since the score on the navicular drop test increases with greater amounts of pronation, and especially with collapse of the medial arch, they were able to conclude that abnormal foot alignment predisposed an athlete to knee injury. In fact, they stated that "hyperpronation of the foot and ankle complex may increase the risk of injury to the ACL."
Conclusion
These retrospective studies clearly demonstrate the correlation between foot position and function, and various biomechanical problems and injuries. Talk to your patients about these factors, and explain why they should be evaluated for custom-made orthotics. I have found that most patients, and athletes in particular, appreciate it when their doctors demonstrate their expertise by discussing research findings which can help improve performance and prevent future problems and injuries.
Kirk A. Lee, DC, CCSP, is a 1980 graduate of Palmer College of Chiropractic and a member of the Palmer College of Chiropractic Post Graduate Faculty. He currently practices in Albion, Michigan. Dr. Lee has lectured nationwide on sports injuries and is a featured speaker for Foot Levelers’ 2008 Spring Seminar Series (call 1-800-553-4860 for information and registration).
References
1. Busseuil C, Freychat P, Guedj EB, Lacour JR. Rearfoot-forefoot orientation and traumatic risk for runners. Foot & Ankle Intl 1998; 19(1):32-37.
2. Freychat P, Belli A, Carret JP, Lacour JR. Relationship between rearfoot and forefoot orientation and ground reaction forces during running. Med Sci Sports Exerc 1996; 28(2):225-232.
3. Dahle LK et al. Visual assessment of foot type and relationship of foot type to lower extremity injury. J Orthop Sports Phys Ther 1991; 14:70-74.
4. Beckett ME et al. Incidence of hyperpronation in the ACL injured knee: a clinical perspective. J Athl Train 1992; 27:58-62.
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Rehabilitation
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Written by Dr. Mark R. Payne, D.C.
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Friday, 29 February 2008 15:28 |
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Everyday, countless patients consult chiropractors seeking a solution for their problems. While some doctors confine themselves to purely symptomatic care, others will recommend treatment well beyond simple relief of pain. Such programs are typically geared toward "correcting the cause" of trouble and often require a considerable commitment of time and money by the patient. Unfortunately, many such programs which rely heavily on a lengthy series of adjustments to "correct" the spine will be doomed to failure.
The ugly truth for chiropractic is that our traditional methods of adjusting the spine do very little to restore normal spinal alignment. Traditional chiropractic care has helped millions to live healthier, happier lives and you can definitely count me as a true "believer." Unfortunately, regardless of what we may believe, numerous studies in reputable, peer reviewed journals have failed to show significant spinal correction from adjustments alone. Correction of spinal misalignment/subluxation has been our profession’s raison d’être since day one. The fact that our main method of treatment, the chiropractic adjustment, does very little to actually correct the underlying structure of the spine is problematic for "corrective care" practitioners, unless they are willing to embrace more effective methods of rehabilitating spinal posture.
Let’s take a very common postural problem, loss of the normal cervical lordosis, as an example. Many chiropractors will X-Ray their patient, detect a chronic loss of cervical lordosis, and prescribe a lengthy regimen of adjustments to address the problem. All of which is fine, as long as both doctor and patient can reasonably expect a positive outcome. Most of the techniques studied to date appear to yield only about four or five degrees of correction on average. The cold, hard truth is that we have very little evidence to demonstrate that ANY method of adjusting is particularly effective at restoring the cervical lordosis. In spite of this, many well-meaning doctors continue to recommend long, protracted programs of adjustments which have little chance of success, simply because that is the way they were trained and they aren’t aware of other treatment options.
So, if adjustments alone aren’t getting the job done, are there other methods we might use to obtain better corrective care outcomes? A 1994 study in the Journal of Manipulative and Physiological Therapeutics shed new light on what might actually work in terms of correcting the cervical curves. The study, the first of its kind, looked at three treatment groups. Group one consisted of thirty-five patients treated using diversified manipulation and drop table adjusting in combination with cervical extension traction methods. Group two received identical adjustment without extension traction and, finally, a third control group received no treatment. At the end of the study (ten to fourteen weeks later), twenty-nine of thirty-five patients in the treatment group one (the traction and adjustment group) had a lordotic curve compared to eleven of thirty-five prior to treatment. The average improvement in curve values was 13.2 degrees. That’s roughly 300 percent better than the four or five degrees of correction typically obtained with adjustments only! Since the original study in 1994, two additional studies produced similar results supporting the use of extension traction methods to restore the normal cervical lordosis.
Caution: Extension traction involves applying traction force with the head and neck in full backward extension relative to the thorax, not simply stretching the spine along the long axis as with typical medical type traction. Pronounced extension movements of the head and neck may be contraindicated for certain patients. I strongly caution all doctors to carefully screen their patients before using any form of cervical extension traction.
In my next article, I’ll cover some of the reasons underlying why it is so difficult to actually achieve meaningful structural corrections with adjustments alone. Between now and then, please take a moment to consider this: For decades, chiropractors have struggled to correct the spine by simply adjusting the column back toward proper alignment. Now, a hundred years into our profession, we are finally starting to understand what it takes to actually deliver on the promise of corrective chiropractic care.
Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. To download a full and unabridged version of this article, link to www.MatlinMfg.com. Interested doctors may contact our office for my FREE REPORT, Suggested Screening Procedures for Patient Safety.
If you are interested in learning more on the subject, call our office. I’ll be glad to share how you can improve your corrective care outcomes by 200-300 percent over adjusting alone without changing your technique or spending a fortune. Contact us at 1-334-448-1210 for your Free Report on patient safety.
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Rehabilitation
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Written by Dr. Mark R. Payne, D.C.
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Tuesday, 01 January 2008 08:38 |
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The seventies and eighties brought huge changes to chiropractic. In the early years, chiropractic was founded around a paradigm of restoring normal spinal alignment (structure), thereby allowing the patient to return to a more optimum state of health (function). Many more traditional chiropractors continue to view patient care strictly within this "structural" paradigm. Consider this from the International Chiropractors Association: "Abnormalities and misalignments of the spine, defined as subluxation(s) in chiropractic science, can and do distort the normal function of the nervous system and may create serious negative health consequences."
In the late seventies, everything changed with the sweeping introduction of the "new paradigm" in chiropractic. Popularized largely by proponents of motion palpation methods, the new paradigm emphasized the importance of restoring normal spinal motion (function) as opposed to more traditional concepts of attempting to correct abnormal spinal structure (alignment). Many doctors were frustrated with the difficulties of actually changing spinal structure and studies were showing that traditional adjustments did very little to actually correct spinal misalignment. In short, the new paradigm found a very willing audience, particularly within many academic circles. With the introduction of the new paradigm, subluxation has come to be viewed almost exclusively as a problem of function (motion). For a sizeable portion of our profession, the importance of healthy spinal structure has become somewhat of a philosophical dinosaur consigned to the bone yard of philosophy.
 For a while, it seemed so simple. No need to worry about pesky post care X-rays showing little or no correction; just make sure the joints felt mobile and everything would turn out fine. Of course, things weren’t that simple. They rarely are. Doctors in the field continued to see patients return with the same old symptoms. Misaligned spines continued to degenerate. Restoring joint mobility was one thing, but keeping the spine mobile and healthy was quite another.
Where the new paradigm fell short was in assuming that normal spinal motion is possible within the framework of sub normal spinal alignment. We now know this isn’t possible. In biomechanical systems such as the spine, motion is certainly a very important measure of function, but it definitely doesn’t stand alone. As it turns out, the intricate coupling patterns of vertebral motion are inseparably linked to the overall architecture of the spinal column. Structure and function, it seems, are just two sides of the same coin.
Consider the two postures in Fig.1 and Fig.2. The patient in Fig. 1 demonstrates a fairly normal posture with the head well centered over the shoulders. The patient in Fig.2 demonstrates forward head posture due to loss of the cervical lordosis. It would be illogical to think the hypolordotic neck would exhibit the same quality of intersegmental motion as the normal neck. Likewise, it is obvious that these two spines will have very different loading factors on the joints’ surfaces. Surrounding musculature is forced to work differently as the origins and insertions change orientation respective to each other. There is a great deal of research to now indicate that healthy structure (posture) is essential for a number of reasons and that structure is intimately wedded to function.
So why start a column about postural rehab with a discussion of two wildly differing paradigms? Simple…. Chiropractic’s "Dueling Paradigms" are at the heart of many of the issues which continue to divide us professionally. Perpetuation of this false dichotomy fosters intraprofessional tension and weakens us politically and financially. Both approaches have value to the clinician and rigid adherence to either paradigm drastically limits your ability to understand and help complex cases. Trying to separate structure and function is totally unnecessary and scientifically unsound. In many cases, it creates a type of professional tunnel vision which can unintentionally shortchange our patients as we seek the cause of their health issues. It is vital that we look at patients from both sides of the equation.
We know a lot more about correcting posture than we did thirty years ago. Today’s doctor has a number of tools available to help achieve real, measurable corrections which simply weren’t possible when our profession first embraced the "new paradigm." I think you’ll find that incorporating postural rehab will bring with it a number of benefits, regardless of your present mode of practice. Most of the treatment and analytical methods we’ll be covering are easily grasped without the need for extensive training, will cost little or nothing to implement, and can be readily applied by doctors of all techniques. From a more practical perspective, you’ll find the straightforward concepts of postural rehab to be very understandable for your patients. For well over a hundred years, chiropractic patients have intuitively grasped the connection between spinal structure and health.
In subsequent issues, I’ll try to share concepts from both paradigms to help you achieve the best corrections of your career. Best of all, I get a chance to show you some of the methods by which doctors of all techniques can easily start to apply proven methods of postural analysis and rehab without investing a fortune in dollars or time. Hopefully, some of the tools and methods we’ll cover in future issues will help make real and substantial structural corrections a practical reality in your practice.
Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. To download a full and unabridged version of this article, link to www.MatlinMfg.com or call 1-334-448-1210.
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Rehabilitation
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Written by Dr. Stephen Kaufman, D.C.
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Saturday, 08 December 2007 17:10 |
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On 2002, at a seminar in Denver, a doctor in his 30’s stated he had had only 90° shoulder abduction for ten years. After applying this technique, his arm immediately rose to almost full abduction of 160°. In Oregon, a doctor had had severe pain and limitation of motion for over thirty years. In front of 150 DC’s, his ROM increased from 30° to 130° and almost all the pain was eliminated within minutes. This improvement maintained itself the next day, which he demonstrated by waving his arm over his head!
I’ve now treated over 35 DC’s and MD’s at seminars with frozen shoulders of many years duration; over 85 percent of them have had immediate restoration of full movement; generally this improvement is permanent after just one or a few treatments.
Painful or frozen shoulder is one of the most frustrating symptoms many DC’s are confronted with. This condition occurs in up to 2 percent of the United States’ population.1,2 Painful and limited shoulder movement of any kind is much more common than true frozen shoulder (adhesive capsulitis). The treatment discussed in this article is extremely effective for all kinds of shoulder pain, if there is pain on movement, and has been successful in well over 85 percent of cases in restoring almost full range of abduction and other movement in minutes.
Non pathologic joint dysfunction responds best, but even severe arthritic degeneration may greatly improve.
Obviously, a true adhesive capsulitis with adhesions or severely arthritic joint will have a worse prognosis than a joint with no pathology that just has pain on motion.1,2,4,7,9 Nevertheless, I saw a sixty-eight-year-old patient with severe crepitus and degeneration of the shoulder joint. His abduction was restricted to 50°, and he had severe pain in the shoulder. I cautioned him that our expectations were limited. However, by the end of the first treatment, he was able to abduct easily to 135°, with no pain! After several sessions, he regained almost full movement to 150° or so, with no pain.
Frozen shoulder can last for years or decades.
Most surgeons agree that this condition is "unresponsive to treatment, including physical therapy, injections and medication"16 and generally self- limiting, usually lasting up to a year. I’ve seen many patients who’ve been frozen for years or decades. Three patients come to mind who had the problem for thirty years; they all responded within minutes with full restoration of pain free movement.
Here’s how to unlock a shoulder that is painful on motion.
These procedures are highly effective at eliminating pain on movement. If there is no pain, but the restricted ROM is due to adhesions or muscle spasm, it’s much more difficult to improve. Sometimes the pain will immediately improve but the motion will stay restricted.
The following procedure is non manipulative, with no thrusting. It aims to realign the soft tissues and retrain them to take the humerus through a normal range of motion as it rides on the glenoid cavity, in shoulder abduction. There are advanced procedures for other planes of movement, but this simple technique is often effective at immediately reducing pain on motion and allowing increased ROM on abduction.
1. Have the patient straighten their arm and actively abduct the arm away toward the ceiling.
2. Note where pain begins.
3. Search the insertion and origins of the deltoid tendons for tender areas; if you find them, apply firm pressure on each area for ten seconds. The deltoid is the prime mover for shoulder abduction; this procedure will facilitate full functioning.
4. Stabilize the patient’s scapula with the palm of your hand pressing anteriorly, and gently pull the humerus posteriorly. Maintaining this pull, have him again abduct the shoulder. He may immediately have less pain when it moves. If so, have him continue to slowly abduct and lower his arm five to ten times. Remember, no thrusting!
5. Note: this procedure will not affect palpatory pain (trigger points) or the subjective pain the patient feels; it is only for pain on movement. The subjective pain will usually improve as the ROM increases. (Other procedures that instantly inhibit trigger points are described in The American Chiropractor, Aug. 2007, "Can Trigger Points Be Turned Off in Seconds, Using Neurological Reflexes?".)
Of course, in your office, you may need to continue treatment for several weeks for an injury of this duration. There are other techniques to restore shoulder internal and external rotation, flexion, adduction, etc., as well as different procedures for instantly neutralizing trigger points in the shoulder. Many shoulder problems are complicated by local trigger points and it may be necessary to eliminate these using Pain Neutralization Technique (P.N.T.), as described in a previous issue of The American Chiropractor.8
Stephen Kaufman, DC, graduated from Los Angeles Chiropractic College in 1978, and practices in Denver, CO. After studying dozens of techniques and being dissatisfied with the lack of consistent results, he finally developed P.N.T. to relieve pain in seconds. For more information, visit www.painneutralization.com. He can be reached at 1-800-774-5078 or 1-303-756-9567.
References
1. Amir-Us-Saqlain H, Zubairi A, Taufiq I. Functional outcome of frozen shoulder after manipulation under anaesthesia. J Pak Med Assoc. 2007 Apr;57(4):181-5
2. Andrews JR. Diagnosis and treatment of chronic painful shoulder: review of nonsurgical interventions. Arthroscopy. 2005 Mar;21(3):333-47. Comment in: Arthroscopy. 2006 Jan;22(1):117-8; author reply 118-9.
3. Bunker TD, Anthony PP. The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg Br. 1995 Sep;77(5):677-83.
4. Cutts S, Clarke D. The patient with frozen shoulder. Practitioner. 2002 Nov;246(1640):730, 734-6, 738-9.
5. Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005 Dec 17;331(7530):1453-6.
6. Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess. 2003;7(29):iii, 1-166.
7. Hand GC, Athanasou NA, Matthews T, Carr AJ. The pathology of frozen shoulder. J Bone Joint Surg Br. 2007 Jul;89(7):928-32
8. Kaufman, Stephen. Can Trigger Points Be Turned Off in Seconds Using Neurological Reflexes? The American Chiropractor, Aug. 2007. p. 40-42.
9. Malhi AM, Khan R. Correlation between clinical diagnosis and arthroscopic findings of the shoulder. Postgrad Med J. 2005 Oct;81(960):657-9.
10. Need patients be stuck with frozen shoulder? Drug Ther Bull. 2000 Nov;38(11):86-8 [No authors listed]
11. Nitz AJ. Physical therapy management of the shoulder. Phys Ther. 1986 Dec;66(12):1912-9.
12. Noël E, Thomas T, Schaeverbeke T, Thomas P, Bonjean M, Revel M. Frozen shoulder. Joint Bone Spine. 2000;67(5):393-400
13. Polkinghorn BS. Chiropractic treatment of frozen shoulder syndrome (adhesive capsulitis) utilizing mechanical force, manually assisted short lever adjusting procedures. J Manipulative Physiol Ther. 1995 Feb;18(2):105-15
14. Wadsworth CT. Frozen shoulder. Phys Ther. 1986 Dec;66(12):1878-83
15. Warner, JJ. Frozen Shoulder: Diagnosis and Management. J. Am. Acad. Ortho. Surg., May 1997; 5: 130 - 140.
16. Frozen shoulder. www.mayoclinic.com.
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Rehabilitation
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Written by Dr. Kirk A. Lee, D.C., C.C.S.P.
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Saturday, 08 December 2007 17:00 |
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An elderly patient enters your office with complaints of low back pain. She is using an assisted device (e.g., cane, walker, crutches). As you watch her walk, you think to yourself, "She looks like Yoda from Star Wars, and I would hurt also if I were walking like that."
Or your patient asks, "Dr. Bones, am I using my cane correctly?" or "Dr. Bones, do you think my walker is at the right height for me?"
Can you answer any of these questions with certainty? After reading this article, you should be able to give your patients an educated answer.
Traditionally, as Doctors of Chiropractic, we do not prescribe or recommend the use of canes, crutches, or walkers. The patient usually has them from a previous condition such as stroke, fractures, and other neuromusculoskeletal conditions. Sometimes they just purchased or rented them to allow them to get to our offices.
We will address some of the most common recommendations for the use of canes, crutches and walkers. Today these devices are referred to as "assisted devices." First, we will talk about how to properly determine the correct height of our patients’ devices and then discuss their proper use.
Our basic goal for the use of an "assisted device" is to help the patient with ambulation. But, even more, it is to have the patient walk as normally as possible without sacrificing safety. As chiropractors, we understand the importance of a normal gait pattern. We have discussed this phenomenon in previous articles. Commonly, our elderly patients present a forward-flexed posture with the head carried in an anterior translation, while the thoracic spine follows with an opposite kyphosis. These postural changes are the results of poor posture, ankylosing, muscle imbalances and degenerative changes. If our patients are using their assisted devices incorrectly, they will develop other compensatory complications throughout the entire musculoskeletal system.
Cane
The patient should stand in an upright, straight posture, shoulders relaxed, with one hand on the cane. Make sure she is holding the cane in a good weightbearing position. Place the cane approximately six inches ahead and to the outside of the patient’s foot. The hand holding the top of the cane should rest so the elbow is about 160 degrees in extension or about even with the greater trochanter on that side.
Walker
With patient standing, place the walker in front of her, so that it is also partially around her on the sides. The patient should stand in an upright, straight posture with shoulders relaxed. Elbows should be almost straight. Once the patient feels comfortable, see if she can apply a push and pull on the walker without having to bend over.
Crutches
The patient should position the crutches with the tips touching the floor about six inches from each foot and out to the sides, in a comfortable, weightbearing position. The patient again needs to assume an upright, straight posture with shoulders relaxed. The axillary pads (top of the crutch) should lie against the ribs about three to four finger widths from the axila (armpit). The handles of the crutches should be positioned so the elbows are about 160 degrees extended or about even with the greater trochanter. This positioning is the same as the cane. Instruct your patient not to press down on the axillary pads. Weight bearing needs to be on the hands and not the axillary (armpit) areas. Axillary pads should be placing pressure into the body.
Walking with a Cane
The patient must understand that she is forming a "triangle foundation" with her feet and the cane. This is for stability. The cane should always be used in the hand opposite the involved leg. The function of the cane is to assist with lateral stability.
Move the cane forward and out to the side. Have patient put her weight onto the cane, shifting the weight off the involved leg. Have her move her involved leg up even with the cane. Make sure patient keeps a good center of gravity for balance. This can be assisted by having her assume a little wider stance, then press on the cane with as much weight as possible on the involved leg. Have her step past the cane with her non-involved leg. Continue this sequence.
With consideration to the different types of canes that are available, the best cane for a patient to use for general ambulatory needs is the basic "straight cane." Other canes, such as the quad cane or hemi cane, are designed for specific patients with specific gait deficiencies. They are designed for patients with limited weightbearing abilities (due to conditions such as stroke, cerebral palsy, fractures), where partial- to non-weightbearing is necessary. What commonly happens for a patient who uses a quad cane for normal ambulation, when they place the cane down, it is usually placed on one or two of the supporting legs, which now creates a rock mechanism as the weight is shifted forward onto the other legs of the cane. This is unlike a straight cane that has only one contact point to allow easy pivoting for better ambulation.
Using the Walker
Instruct the patient to pick the walker up and place it forward a little. Step into the walker, first with the involved leg and then with the other. Have the patient put the involved foot or leg forward and place it on the floor. For non-weightbearing gait or partial weight bearing, the patient now needs to push on her hands and, lifting her weight, step forward with involved leg, then uninvolved leg, placing it next to the involved leg. Repeat this sequence with each step. Place only weight bearing on the involved leg.
Keep reminding the patient of the importance of maintaining as normal of a heel-to-toe gait as possible and avoid limping.
Using the Crutches
The patient must keep in mind the proper positioning of the crutches. A triangle position of the feet and crutches makes her more stabile. When walking, maintain weight bearing on one leg and put both crutches forward. Place all pressure on the hands, and step past the crutches with her opposite foot landing on the heel first (heel strike) for balance.
Now the patient’s position should present as a backward triangle. If patient can put weight on the involved foot, we would have her try to place the crutches forward and then step forward with the involved foot up to the crutches, followed by having her step past the crutches with her uninvolved foot, placing her uninvolved foot on the ground with a heel-first landing. This maneuver is commonly used for weak legs and restricted weight bearing.
When your patient is able to bear considerable weight on the involved leg and foot, the gait pattern will resemble the pattern used for cane walking. Move one crutch, or one foot at a time (4 point) or move one crutch and one foot together (2 point).
Ultimately, the important issue with our patients and walking devices is that they are comfortable with both their use of the device and are maintaining as upright and stable posture as possible. This includes walking with as close to a normal gait pattern as possible so we do not elicit compensatory stresses throughout the musculoskeletal chain, thus allowing our patients to maintain their chiropractic adjustments for better patient outcomes.
I would like to thank my wonderful wife Terri for her advice and assistance in writing this article.
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan. He is very active with the Michigan Chiropractic Society serving on the legal and government affairs committees.
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