Knee, foot and ankle pain

Knee (4)

Attention to the knee should be undertaken as a result of the following:

Reduction or alteration of knee range of motion. Chondromalcia of the patella Osgood-Schlatter syndrome Shin splints (periostitis) Patellar effusion or bursitis of the knee Referred pain to the ankle or foot Osteoarthritis Other Evaluation of the knee and related structures is indicated when a patient complains of pain within the joint or periarticular tissue, swelling with or without pain, joint instability or joint stiffness.

A study (4) has reported that injuries to the knee and ankle accounted for 25% of all injuries.

In addition trauma, overuse injuries and biomechanical dysfunction also compromise a significant proportion to knee problems.

An increase in evidence suggests that conservative management and injury prevention strategies of even serious injuries to the knee yield the most effective clinical outcomes. Many of the following conditions may be related to subluxations of the knee that can be adjusted using low force and highly specific Activator Adjusting Instrument (5).

Foot ankle and related structures (6)

Evaluation of the foot and ankle is indicated when a patient complains of pain, weakness or stiffness in that region or when abnormal biomechanics is observed. Indicators for assessments are: Reduction or alteration of ankle range of motion Plantar fasciitis Inversion sprain of the ankle Achilles tendonitis, posterior shin splints or calf muscle sprain Biomechanical disorders of the foot and ankle Altered gait pattern Abnormal shoe wear Osteoarthitis Tarsal tunnel Other

Frequent sites of pain are the medial aspect of the plantar surface of the foot at the instep, at the insertion of the Achilles tendon to the calcaneus, and at the region of the talofibular ligament just anterior and inferior to the lateral malleolus.

Although (7) traumatic injury such as sports injuries can cause the signs and symptoms of the lower extremity, leg length inequality are some of the other causes.

This altered alignment / physiological (2) function to the musculoskeletal system notably cause changes in tissue sensory beds, which have been implicated in subluxation theories (1).

The effects of altered sensory input on central and efferent activity is of great interest to clinicians as Chiropractic analyses have been developed in an attempt to locate dysfunction or subluxation.
In Chiropractic, we use the protocol as described by Activator Methods Chiropractic Technique (8), in the assessment of the foot / ankle and related structures subluxations and treatment.

What makes person with a knee or foot or ankle and related structures complaints a Chiropractic patient is What makes a person a Chiropractic patient is based on Chiropractic's principle that joint dysfunction termed "Subluxation" is the cause of a patient's signs and symptoms. The American Chiropractic Association has defined subluxation as "the alignment / physiological function of a motion segment as being altered although contact between the joint surfaces remains intact (1)."
This altered alignment / physiological function to the musculoskeletal system notably cause changes in tissue sensory beds, which have been implicated in subluxation theories.

The effects of altered sensory input on central and efferent activity is of great interest to clinicians as Chiropractic analyses have been developed in an attempt to locate dysfunction or subluxation.

 Changes that occur due to joint alterations from micro trauma, sustained loading such as in an abnormal posture, repetitive motions, many times work related may also be a mechanism of injury.

Sports, hobbies, and recreation which may lead to acute or chronic dysfunction and pain syndromes. In addition the effects of ageing, or of a lifetime of micro trauma and macro trauma injuries leading to degeneration immobilization and pain.
Connective tissue changes as a result of inflammation and oedema reorganize tissues, possibly perpetuating immobility and further degeneration.
Under normal conditions the nociceptive system (2) is silent because the high threshold of the nociceptor does not receive the amount of sensory stimulation necessary to initiate an action potential.

However when adequately stimulated nociceptors fire continuously in a non adaptive nature until the stimulus is removed.
Thus the person is apprised of a damaging stimulus that causes the pain as long as it persists. Three types of stimuli excite the nociceptors; mechanical, thermal, chemical.

It is this subluxation that we as Chiropractors, find and restore to normal alignment and hence function.
What we do with the Activator Adjusting Instrument is adjust these subluxations, in doing so we initiate passive joint movement , which results in stimulating movement as well as the nerves that sense movement, this stops the nerves that are responsible for pain from being active, and hence abolish or diminish pain (3).

Creation of normal joint structure and function through Chiropractic adjustments may cause the nerves responsible for sensing normal joint movement, and those nerves responsible for sensing pain to work appropriately, meaning that when the joints are working properly then the pain fibre nerves remain dormant, only when there is joint damage or dysfunction are the pain fibres to operate (3).

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