Are Knee Injuries Really Knee Injuries?

by Dr. Kirk A. Lee, D.C., C.C.S.P.

We see patients in our offices daily with arthritic knees—sometimes bilateral, other times affecting only one leg. Some patients can point to an old football injury or car accident as the probable cause. But, frequently, they cannot tell us why their knee hurts, only that they have a new friend called "Arthur" that causes their knee to swell and hurt.

Each day we are faced with patients whose musculoskeletal complaints may not appear spinal related. Many times no mechanism of injury is retained from our consultation or examination. Orthopedic tests are quite often absent of a positive finding other than maybe a little discomfort. So what is the cause? It is easy to figure out from a diagnostic view of the patient who sustained a direct injury to the knee from a fall, or car accident, or of the athlete who received a traumatic blow to the knee.

In runners, the chief complaint is commonly lower leg pain. This could be determined as tibial stress syndrome (shin splints), or perhaps strains of the soleus and gastrocnemius muscles. The second most common complaint is of the knee—generalized soreness anywhere around the knee to advancing conditions like chondromalacia. The foot is third, with conditions like plantar fascia, bunions, blisters, ankle sprains and strains. Fourth is the hip, followed by the upper leg and, finally, low back conditions. As we look at this list of most common areas of chief complaint, do you feel the order is correct?

When we analyze the gait cycle, we have a good understanding from previous articles and our own general knowledge that the foot is made up of three arches (medial, anterior and lateral) and three distinct segments (rearfoot, midfoot, forefoot). Together, when patients ambulate, they transition from some form of heel strike through midstance followed by toe-off. We know all three arches work together for structural support of the foot. If one arch is affected by misalignment, plastic deformation or wrong or ill-fitting shoes, it will affect the normal movement pattern of the foot. We know that, when the foot goes into its pronation pattern (foot rolling inward), the tibia medially rotates (turns in). This medial rotation can be excessive as in hyper-pronation or restricted as in hyper-supination, or it can be an abnormal movement pattern through the foot, as in a patient who just picks the foot up and sets it down and does not have heel-toe transition. The stresses placed at the knee are excessive.

We also know that subluxation complexes of the spine and pelvis will affect posture and alignment (which in turn affects Q angles), while anteriority and posteriority of the hips affect the anglulation of the femur. When we think about the knee joint, itself, it is a hinge joint. It primarily functions in flexion and extension. It has the simplest joint movement and one of the less stressful joint movement patterns.

When you think about a door hinge and how many times it swings back and forth, what usually causes a door hinge to start to fail? It’s not that it wears out. It’s usually because the door, itself, starts to misalign or the house shifts and the door no longer closes properly, causing angulated stresses on the door hinges. This is no different than what our bodies do. There is no doubt that, "neurologically it is from above-down-inside-out" but, "biomechanically, it is from below-up." Or to put it another way, "When the foot hits the ground, everything changes." These phrases just point out that, in our treatment of patients’ knee conditions, we must always look to what the real cause of the knee condition is and not just look at the knee itself for the treatment of the condition. We must evaluate abnormal patterns in gait and posture, and we must help our patients with treatment plans that can include rehabilitation, specific chiropractic adjustments (CMT), or supportive measures like custom-made Spinal Pelvic Stabilizers. Our patients can be assured they are getting the best we have to offer as doctors of chiropractic.

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. Dr. Lee can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Healthy Doctors: Practicing and Preaching

by Dr. Mark R. Payne D.C.

Can you imagine an overweight doctor counseling patients on nutrition? How about a physician who smokes urging patients to quit? Or a well-intentioned couch potato handing out exercise advice? We’ve all encountered doctors who dispense advice freely but rarely seem to follow it themselves. The inevitable result, of course, is that no one ever takes such advice, or the doctors who dole it out, very seriously.

I know plenty of doctors who recommend extensive programs of corrective care to their patients, but are totally unwilling to put in the effort or discipline needed to really correct their own spinal problems. But there’s a flip side to this coin as well. Over the last few years, I’ve encountered a number of doctors who recommend different standard of care for their patients than for themselves. Here’s an example. A middle aged chiropractor came to our clinic to determine the cause of his chronic neck pain and headaches. The loss of cervical lordosis and associated spinal degeneration was readily apparent. The doctor, a proponent of lengthy programs of adjustment only care, had been adjusted weekly for decades. He was quite aware of the advancing degeneration and lack of correction in his own neck, yet had never altered his own treatment program. Instead, he just continued to drop by a colleague’s office for a quick adjustment whenever his symptoms worsened.

I developed a simple self care program for the doctor consisting of Compression Counterstressing traction and basic posture exercises. I explained that the advanced disc degeneration would make full correction difficult at this point, but that continued traction and exercise should improve the posture, slow further degeneration, and keep symptoms at bay. In just a few weeks, his symptoms were dramatically improved. I spoke with my colleague occasionally and everything seemed fine—at least for a while.

Six months later, he returned to the office. The headaches and neck pain had returned—slowly at first, but gradually increasing until now they were just as bad as ever. You guessed it. Almost as soon as the symptoms disappeared, our friend discontinued traction and exercise and was back into his old routine of getting adjusted whenever symptoms occurred. I have to confess that I was pretty flustered. We were making great progress and, yet, he had lapsed right back into the same old routine. Biting my tongue, I reinforced the importance of dealing with the postural aspects of the problem and politely pointed out that, if thirty years of adjustments hadn’t fixed it yet, it was unlikely more of the same would do much good.

The good doctor is once again feeling better and is working harder at his home rehab program. That would conclude our story except for one little sticking point. Absolutely nothing has changed about the way our friend approaches the treatment of his own patients! Here’s a doctor who has seen first hand that adjustments simply won’t correct some problems. He understands how contracted soft tissues perpetuate postural subluxation and the importance of rehab. He knows all this but hasn’t changed anything in his office.

Instead, it’s just business as usual. Just like always, patients get an exam, a report of findings focused on segmental dysfunction/misalignment, and a fairly lengthy program of "adjustments only" care to correct their problems. There’s no objective analysis. No way, other than symptomatic improvement, to measure progress and certainly no effort to actually rehabilitate and strengthen the spine. Whenever I call his hand, he always says he’s going to implement posture based rehab into his clinic "pretty soon." It would seem that old habits really do die hard.

In the end, much of what we do comes down to little more than habit and routine. Whether we are talking about our own health, how we treat patients or manage our practices, much is done simply out of habit. We do what we do, because it’s what we’ve always done. There’s a certain amount of intellectual inertia which tends to keep us all immobile. We fail to do the things we know are important for our own health. We don’t look objectively at our own treatment outcomes. We postpone learning new skills because we are comfortable in our old rut. We hope the practice will grow and prosper but we never change a thing.

The specific challenges are different for each of us, but the underlying theme here is constant. If you want better results, you’ve got to rise out of the rut. Lip service doesn’t cut it. Only actions count. Some of us need to get off the couch and head to the gym, if we expect our patients to exercise. Maybe we could drop a few pounds if we want to change the way our patients eat. That’s practicing what we preach. But, as we learn and grow, it’s also vital that we share the benefits of our new discoveries with our patients as well. That’s preaching what you practice.

Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. To request more information on managing the scoliotic patient with postural chi ropractic methods, call 1-334-448-1210 or link to www.MatlinMfg.com.