The longer that field chiropractors are in practice, the more they observe how patients do not understand the breadth of the areas of the body and health conditions that they can treat. Patients already know and trust your care and the positive results that you can provide.
Making sure your patients and community know you have this expertise can be a great way to keep current patients coming back and expand your outreach to prospective patients. This is your opportunity to educate them about the other conditions that you can address, such as:
Ankle Sprains
Ankle sprains are the most common and frequent lower-extremity injuries you will likely see in your care. In my practice, I’ve observed that 90% of ankle sprains are inversion sprains (versus eversion sprains) because of the ankle’s anatomy and mechanism of injury. Notice the location of the medial and lateral malleoli on the ankle picture.
The medial malleolus is superior (higher) to the lateral malleolus, so the support for the inner ankle region is far less than that of the lateral ankle. The lower lateral malleolus provides support for the outer portion of the ankle joint, so eversion sprains are less likely to occur.
When the ankle/foot turns in, the lateral ankle ligaments get stressed, and that is where most of the patient’s symptoms will be. You will wade through the swelling and the discoloration on the outside of the foot/ankle and rule out any type of fracture or tearing of soft tissues. Obviously the more swelling present, the longer it may take to treat the area.
Utilizing the appropriate physiotherapy modalities to help you with swelling or the acute, subacute, or chronic state of the ankle will help you decide which adjustments will be effective. Remember that with any sprained ankle, the calcaneus, talus, cuboid, and navicular bones on the affected foot are key bones to adjust. The most important of those bones that gets particularly subluxated is the cuboid bone.
There are patients who can walk around for months to years with a previously sprained ankle that was never properly adjusted by a chiropractor. Patients just compensate by shifting their weight off the affected foot/ ankle, which then sets the scene for the rest of the body to be thrown out of alignment down the road. Often, a chronic ankle sprain is the catalyst for biomechanical stresses that will affect the knee, hip, pelvis, spine, and shoulders.
Shoulder Pain
Patients may potentially come to your clinic with numerous types of shoulder injuries. They range from the more serious torn soft tissues to the more mundane general shoulder discomfort. The shoulder region seems complicated at first glance because there are many moving parts. However, recall that at the heart of all the shoulder conditions, the GH, AC, SC, and scapulothoracic joints are all out of alignment to some degree.
Whatever exam and evaluation methods you use to assess alignment or stability, make sure you check all these joints. Absent anything else, your palpation skill will allow you to feel the misalignments in these regions. Shoulder sprains/strains, separation, impingement, tendonitis, bursitis, rotator cuff tears, labrum tears, and frozen shoulder are some of the major ailments that patients can present to you when seeking your help.
When you assess the patient and determine if there is actual damage to bony structures and soft tissue, the resulting treatment you choose will be appropriate. The physiotherapy modalities, adjustments, support, and rehab will be dictated by the patient’s condition. Don’t forget to adjust all the shoulder joints since it is common for practitioners to focus mainly on the GH and not so much on AC, SC, and scapulothoracic joints. Assess and treat all the shoulder joints.
I must also add that the shoulders are a source of spinal pain. All too often, a patient presents with pain in the neck and upper/mid-thoracic region. In most of these cases, the shoulders are not “hurting.” When shoulder joints are out of alignment, they may cause lowgrade discomfort or pain that does not even register in people’s conscious brains. The rotator cuff muscles, trapezius, levator scapulae, and C/T paraspinals are often hypertonic secondary to shoulder biomechanical instability, and that will lead to the patient feeling more neck and thoracic pain. Check the shoulders whenever you have neck and thoracic pain to see the whole picture of what is going on with the patient’s current state.
Temporomandibular Joint (TMJ):
For a patient presenting with a headache (of any kind), neck pain, vertigo, dizziness, or proprioceptive complaints, it is prudent to check the TMJ. As a rule, don’t rely on the patient’s dentist to be a TMJ expert. Many of them are fantastic at dealing with teeth, but the TMJ is a specialty. The TMJ is often overlooked or ignored, but it is one of those joints that really makes you stand out as a chiropractor.
As a DC, you can evaluate both TM joints, provide some soft tissue and/or physiotherapy, and perform external work on the jaw. In some states, even working inside the mouth is permitted. I suggest you assess bilateral joint motion with the patient opening and closing their mouth to see how symmetrical the movements are. You can correlate the jaw movement/ deviation and stress patterns to how many of the muscles are working. There are quite a few important muscles in this region, such as the cervical paraspinal, suboccipital, trapezius, lateral pterygoid, medial pterygoid, masseter, temporalis, and suprahyoid (strap) muscles.
It does take some practice to get more proficient with TMJ treatments, but you can provide a patient with a lot of help. The jaw is resilient and responds to adjustments and realignment quickly. You will also be able to tell if the patient is clenching or grinding their teeth at night because the jaw does not seem to stabilize within four or five visits. These individuals may benefit from working with their dental professional and being fitted for a mouthguard.
Remember that adjustments or mobilizations can be as simple as teaching the patient to use their thumbs to “push” the aberrant motion side of the mandible back to the center. They can be as complicated as using your fingers inside the patient’s mouth to strip the lateral pterygoid muscle. There are a few “adjustments” for the jaw using the hands, but little force is needed, and they are more like impulses than anything else. Using a spring-loaded instrument, your hands, or doing gentle work depends on your scope of practice in your state and your level of comfort. I highly suggest you learn how to treat this area and don’t ignore it. A TMJ that remains out of alignment from a head or neck injury can cause problems for years to come.
Feet and Foot Pain:
I get the most comments from patients about this area. Many have been to foot practitioners and specialists, but they are not taught about movement patterns, arches, or how the feet affect the rest of the body.
One of the most important observations I have seen for over 25 years is that patients don’t often present with painful feet. Many patients don’t realize that although they have no pain in their feet currently, their feet are contributors to the pain they have elsewhere in the body. One of the reasons I always tell other chiropractors to check every patient’s feet is illustrated by the Crooked Person diagram.
There are 26 bones and three functional arches in each foot. This equals 52 total bones in both feet. The body has 206 bones total, which means about 25% of all your bones are in the feet. They are important, and when there are excessive foot pronation and supination issues, those bones move out of alignment. You have the unique expertise to realign those bones.
In my practice, I see 99% of my patients excessively pronating, so understanding how the foot bones are misaligned will allow you to consistently help patients with foot-related issues. Plantar fasciitis, neuromas, metatarsalgia, and Achilles tendonitis are the popular ailments of the feet that patients will tell you about. Using weight-bearing posture analysis, foot scanning, ROM, and palpation, you can understand the biomechanical deficiencies. Adjustments and prescribing custom flexible orthotics that support all three arches of each foot are key to helping your patients achieve lasting relief.
I want to remind you to keep your minds open and utilize different adjusting techniques and methods for treating the extremities. Manual/diversified, instrument adjusting, drop table, and blocking are where you excel as a practitioner because you choose the method that will work best for your patient on that particular visit. You also are able to change techniques as the patient’s condition improves. It’s all part of the progression of your treatment plan.
Kevin M. Wong, DC is a graduate of the University of California, Davis, and a 1996 graduate of Palmer Col^ r; lege of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, CA. As a member of Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting.
