Adjustment of Lower Extremity Joint Subluxation-Fixations
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 1 from RC’s best-selling book:
“Lower Extremity Technique”
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Chapter 1: Adjustment of Lower Extremity Joint Subluxation-Fixations
This chapter describes adjustive therapy as it applies to articular malpositions of the proximal femur, knee, ankle, and foot. Manipulations to free areas of fixation are also explained.
Articular disorders of the lower extremities are quite common, both as primary and secondary disorders, and may have far-reaching effects. For example, the hip works as a functional unit with the pelvis and indirectly the lumbar spine, as well as the knee, ankle, and foot, which have a direct influence on both adjacent segments and body structure as a whole.
The knee is the largest joint of the body, and it is fairly centered between long bones above and below. Thus, it is frequently subjected to strong leverage forces. Without much soft-tissue protection, the knee is easily subject to trauma; however, this same attribute offers helpful bony landmarks that are easily palpable.
Total body weight from above is transmitted downward to the leg, ankle, and foot in the upright position, and this force is greatly multiplied in locomotion. Thus, the ankle and foot are uniquely affected by trauma and static deformities infrequently seen in other areas of the body. For most clinical purposes, the lower leg, ankle, and foot can be considered to work as a dynamic unit.
Screening Tests for the Lower Extremity as a Whole
Human architecture is a complex design incorporating many vertebral and extra-vertebral articulations, all of which can function normally or abnormally. Gillet has found that when extra-vertebral articulations are fixated, they have a tendency to produce and reproduce spinal subluxations. Thus, the analysis and elimination of causes must consider the body a whole.
Most subluxations were considered by pioneer chiropractors to be the result of trauma. We now realize that this is not the case and that many subluxations can be the effect of various intrinsic stresses (eg, mechanical, chemical). In general, chiropractic authorities believe that these subluxations will continually recur if the reasons for their existence are not also eliminated. In fact, it can be generally considered that any subluxation that has been effectively normalized and which tends to recur should be considered as being secondary to some other spinal or extra-spinal cause.
During the evaluation of lower-extremity neuromusculoskeletal disorders, it is well to initially seek signs of atrophy, hypertrophy, fibrillations, and abnormal movements such as tremors, myoclonus, chorea, athetosis, tics, etc. Gross posture, structural attitude, and deformities should also be noted. The range of joint motion at each joint can be measured with a goniometer during the orthopedic part of the examination. Then voluntary power of each group of muscles can be tested against resistance and compared bilaterally. Abnormal tonus (flaccidity, spasticity) can be determined by passive movements.
Lower Extremity Postural Balance
The gravity line passes slightly anterior to the S2 segment, behind the axis of the hip joint, slightly anterior to the transverse axis of rotation of the knee (slightly posterior to the patella), crosses anterior to the lateral malleolus, and through the cuboid-calcaneal junction to fall between the heel and metatarsal heads when viewed laterally during good postural balance. When viewed from the back, the lateral line of gravity passes through the spinous of L5 and the coccyx and bisects the knees and ankles. When viewed from the front, a line dropped from the anterior-superior iliac spine (ASIS) should bisect the patella and the web space between the 1st and 2nd toes.
Leg Length Discrepancies
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