here is no question that the root of chiropractic lies in the use of the hands on the axial spine and pelvis. It has been something originally developed by D.D. Palmer and passed down the ages from our forefathers to us. It is important to remember the roots of our profession as placing the hands on the spine releases innate power so the body can heal itself. Traditional chiropractic has helped us all form a strong foundation for the knowledge we use in daily practice. In school, we start with the basic understanding of anatomy and working with patients helps reinforce the key relationships between the bones, joints and muscles. In just about every patient, we observe the biomechanics of not only the spine, but of the extraspinal areas as well.
The concept of extremity adjusting has been growing in momentum, especially in the last 10 years. In the past some have been lukewarm at the idea of truly adjusting anything but the spine. They felt extremity adjusting was not part of chiropractic. If we adjust the spine, it should be able to heal the body, right? In many cases, this is quite true. In many cases, however, this is not.
There are instances when the extremities themselves are the standalone causes of pain and without treating them, we are not addressing the true nature or source of the problem. Just as we ask patients to be open minded when getting their spine adjusted for the first time, so must we be when considering the extremities.
Chiropractic Is Not Just For The Spine!
One of the main reasons why some of us do not gravitate towards adjusting extremities is because of the perception we are saddled with by the general public. Chiropractors are stereotypically pigeonholed as "back and neck doctors.” Patients do not realize that we can also treat the extremities. In fact, many of your patients right now have no idea you have the ability to do this; unless you tell them and show them!
Getting exposed to extremity anatomy and adjusting in chiropractic school was one thing. Really using the information and developing your skills in this area is another. Whether you are seasoned at working with extremities or a novice, practice, practice, practice helps bring confidence and great results.
It is amazing to assess someone's foot, ankle, hip, hand, wrist, shoulder or TMJ when they are in pain. The power and effect of our hands to realign those bones is marvelous. Seeing the improved motion, muscle relaxation and pain reduction is just as amazing in an extremity as it is in the spine.
Extremity Care Contributes to Whole Body Care:
Often there are examples of spinal pain caused by an extremity. The most common example of this in my practice is lower back pain that is actually coming from the collapse or over pronation of the three arches of the feet. Once the foot arches drop downwards and the feet fall to the floor, there is an inward rotation of the tibia and femur bones that put lateral pressure on the hips. The resulting tipping of the pelvis stresses the lumbosacral region creating muscle hypertonicity, altered biomechanics and pain. This example is so common in my office that if I missed checking the feet, I would never be able to stabilize the lower back.
Another example is upper/mid back, neck pain and headaches that are caused by shoulder girdle misalignments. When the glenohumeral, the acromioclavicular and the sternoclavicular joints are subluxated, the humeral head tends to move anteriorly. The resultant stress on the clavicle, ribs and scapula eventually create hypertonicity in the surrounding muscles. Of these, trapezius muscle hypertonicity (due to its’ origins on the mid/upper back, neck and occiput) especially creates a lot of pain and reduced shoulder biomechanics. Very often, shoulder misalignments will present as spinal pain. If we miss the shoulder joints, it will hard to completely stabilize the region.
Almost anywhere there is a joint in the body, chiropractic can help!
Chiropractors are stereotypically pigeonholed as "back and neck doctors.”
Just about every joint in the body has the potential to subluxate or misalign. How many times have you found someone’s jaw to be out of alignment? How about when ribs go out of place? The extremity joints are prime examples of these. All of them can exhibit the same kind of pain, local muscle hypertonicity and swelling that we see in the spine.
Often, these smaller joints are located in areas of the body that are very critical to everyday activities. Try going about your daily routine when your wrist is hurting or you can’t put weight on your foot/ankle because these areas are out of alignment. What is important here is for you to think of the big picture. Although we should always address the pain, try not to chase it! The body likes to fool us sometimes.
Add an element to your skill set that will help you treat more patients.
The more proficiency you have with analyzing and adjusting the extremities, the more patients you will help. It is rare to find any patient who does not have some kind of ache and pain in an extraspinal body part. The more people you treat, the more extremity issues you will find. It’s a bit tricky at first, but you will get the feel for working with them.
The nice thing about adjusting extremities is that there does not tend to be as much soft tissue to have to work through or push through to get right on the bones of the joint. Palpation is a bit easier as a result. This allows you to really feel when the bones are misaligned, especially comparing bilaterally. This ease of palpation allows you to assess range of motion, swelling, tenderness and general anatomy of the area without too much difficulty.
Go the Extra Mile for Your Patients!
The body ends up being a sum of its parts. Your knowledge of the spine can only be strengthened by your extremity work. You start to put together patterns that the body exhibits when the extremities are out of sorts. It helps you become a better practitioner and it opens a whole new source of patients you can help.
Extremities have always been so fascinating to me but getting really proficient with them is a skill I keep developing every day. I hope that wherever you are in your career, you see extremity adjusting as an important component to your practice. I hope working on these areas enhances your practice as much as it has mine. Dr. Kevin M. Wong is an expert on foot analysis, walking and standing postures and orthotics. Teaching patients and chiropractors is a passion for him, and he travels the country speaking about spinal and extremity adjusting. Dr. Wong practices full-time in Orinda, California. Contact Dr. Wong at 925-254-4040 or