How Long Do Your Adjustments Hold?
By Mark N. Charrette, DC
After over four decades of practice, my experience tells me that the more symmetrical the body’s weight distribution, the longer a chiropractic adjustment will hold.
In this article, I will briefly discuss an aspect of body balance — the pedal foundation — and its implications for body balance.
Starting from the Ground Up
Over 50 years ago, in the Belgian Chiropractic Research Notes, Dr. Henry Gillet stated, “The base of the spine is not the sacrum; it is the ischia in the sitting posture and the feet in the standing position.”1
Starting from the ground up, I typically examine the patient for asymmetries and imbalances in the feet, knees, hips, pelvis, shoulders, neck, and lateral curves. In nearly all cases, I find the feet to be involved.
The most common pattern I find in the feet is bilateral asymmetrical excessive pronation.2,3 We’re all familiar with the appearance of foot and ankle pronation and the sight of ankles/feet that seem to roll inward. We observe ankles/feet that appear to roll inward. All three arches of the feet (the medial longitudinal, lateral longitudinal, and anterior transverse) lose their height, resulting in a longer, broader, flatter foot when functional or weight-bearing. This progression appears to take several years to manifest, usually through adolescence, when the lower extremities’ growth centers are still active.
Multiple visual indicators accompany bilateral pronation. These include:
Foot flare/toe-out, which stems from the imbalance of the feet’s invertors and evertors
Asymmetrical posterior/lateral heel wear
Achilles tendon bowing
Callouses on the second, third, and fourth metatarsal heads
Increased Q-angle of the knees
This excessive foot pronation pattern is linked to other postural distortions within the human frame. Four global postural distortions are almost always found together. These include:
Bilateral asymmetrical excessive foot pronation
Pelvic tilt
Anterior translation of the pelvis
Anterior translation of the cervical spine
Leg Length Inequality
Mechanically, we face a critical question: How can we level the femur head heights after an adjustment when the patient has bilateral asymmetrical pronation?
When the functional foot reaches maximum pronation at midstance, the distal femur and proximal tibia surfaces undergo internal rotation, corresponding to the internal rotation of the femur heads.
Excessive pronation or hyperpronation results in a functional discrepancy in leg lengths. This imbalance affects muscular tension as well as the degree of weight borne by different joints. As the body’s strain increases, endurance may decrease, causing routine motions to require more muscular effort and lead to fatigue. It is common for pain and discomfort to be the body’s responses.4
This can create a formidable challenge to having the height of the femur head level when the patient is weight-bearing after an adjustment.
Plastic Deformation of the Feet and Other Joints
For the pelvis to be level, the patient must have a level foundation, starting with the feet. With each step, degenerative changes in the muscles, joints, and connective tissues of the feet worsen and compound. The ligaments of the feet, particularly the plantar fascia, undergo plastic deformation.
Merriam-Webster.com Dictionary defines plastic deformation as “a permanent deformation or change in shape under the action of a sustained force.” Considering the thousands of steps and the force exerted on our feet during heel strikes, which is multiple times our body weight, it’s not hard to comprehend how this occurs.
Most chiropractors adjust extremity articulations, although some engage in this practice more than others. In his 1910 book, The Chiropractic Adjustor, D. D. Palmer stated, “Chiropractors adjust any and all of the 300 joints of the body, more particularly the joints of the spinal column.”5 The problem is that chiropractic foot adjustments are very difficult to hold because arches are stabilized primarily by ligaments, not muscles. 6
Most of our patients are unaware of this, but we average between 7,000 to 10,000 steps daily. Many people even exceed 14,000 steps daily. Upon heel strike on a surface, a force equivalent to 2.5 times one’s body weight travels up the leg to the lower back, spine, and head. When one runs, the force upon heel strike increases, reaching an equivalent of 3.5 times one’s body weight.
The issue is that the foot’s arches are supported by strong ligaments rather than muscles. After enduring 7,000 to 10,000 heel strikes per day — for as long as you’ve been walking and running — the ligaments that support the arches in the feet become stretched permanently. It is akin to stretching a plastic bag; it doesn’t bounce back to its original form after being pulled. The same applies to the ligaments in your feet. As they become permanently stretched, the foot’s stability decreases.
Conclusion
Understanding the key role ligaments play in the integrity of the weight-bearing arches of the feet leads me to believe that while adjusting the feet is necessary, the effects are often short-lived because of repeated heel strikes throughout the gait cycle without proper support.
This supports my choice to use custom, stabilizing foot orthotics. These orthotics offer support to all three arches of the feet, facilitate optimal or normal ranges of motion, and restrict excessive pronation or hyperpronation. The results include balanced subtalar joints, knees, and hips, as well as stable pelvis and shoulders.
Drawing from my extensive clinical experience, I’ve found that the sustainability of chiropractic adjustments I administer is notably enhanced when the feet are balanced, thus facilitating a more even distribution of the body’s weight-bearing forces.
About Dr. Charrette
Dr. Mark Charette is a 1980 summa cum laude graduate of Palmer College of Chiropractic and a former All-American swimmer. He is a frequent guest speaker at chiropractic colleges and has taught over 2,200 seminars worldwide on extremity adjusting, biomechanics, and spinal adjusting techniques. He has authored a book on extremity adjusting and produced an instructional video series. His lively seminars emphasize a practical, hands-on approach.
References
1. Gillet H, Liekens M. Belgian chiropractic research notes. 11th ed. Motion Palpation Institute. 198. 85–86 p.
2. Langer S. Structural leg syndrome. JAPA66; 1976. 723 p.
3. Basmajian JV, Stecko G. The role of muscles in arch support of the foot. J Bone Joint Surg Am. 1963 Sep;45:1184-90. PMID: 14077983.
4. Hetsroni I, Finestone A, Milgrom C, Ben-Sira D, Nyska M, Mann G, Almosnino S, Ayalon M. The role of foot pronation in the development of femoral and tibial stress fractures: a prospective biomechanical study. Clin J Sport Med. 2008 Jan;18(1):18-23. doi: 10.1097/JSM.0b013e31815ed6bf. PMID: 18185034.
5. Palmer DD. Text-book of the science art and philosophy of chiropractic for students and practitioners. Portland Printing House Company. 1910. 228 p.
6. Huang CK, Kitaoka HB, An KN, Chao EY. Biomechanical evaluation of longitudinal arch stability. Foot Ankle. 1993 Jul-Aug;14(6):353-7. doi: 10.1177/107110079301400609. PMID: 8406252.
