Over the years, I have equated what we do as chiropractors during our clinical evaluations to being “diagnosis detectives.” In my practice, evaluating an injury like a detective would examine a crime scene has proven to be one of my most successful clinical habits.
None of our patients comes into our office with a deficiency of low back pain or knee pain that their body then decides to express. It is our job to help identify the underlying reasons for which they incurred such presenting complaints if we are going to have a lasting impact.
On the Case: Knee Pain
If we look specifically at knee pain, we know numerous therapeutic interventions help alleviate the discomfort associated with the plethora of functional and structural disturbances affecting the knee. But should the knee be the main area of focus? When I put my diagnosis detective hat on, I typically see the knee as an area of what I refer to as a “victim zone.” At a crime scene, there are victims, criminals and mob bosses, and the sooner you identify the mob bosses who encouraged the criminal actions, creating the victims, the better you will able to solve the case.
I view the human body in the same regard. Many times, the areas of the body our patients come to see us about are really just the victim zones. Unfortunately, too many practitioners focus on victim zones as the target for their treatments. Without taking the time to properly identify the reasons why that area became a victim in the first place, patients can be left with ongoing aches and pains that could have otherwise been resolved.
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For example, when looking at the knee, it is one of our largest joints positioned between two of the longest bones in the human body. The knee joint experiences immense transmission of forces through it each day and with each weight-bearing action. Many different criminals can increase the strain experienced by the knee. One such criminal is excessive pronation or supination of the ankle, leading to altered kinetics and kinematics of the knee. Another key criminal is weakness of the hip musculature. The gluteus medius / minimus /maximus can be culprits as well.
Weakness of the gluteal muscles leads to an inability to properly control femoral positioning and most commonly, excessive internal femoral rotation. The uncontrolled internal femoral rotation then leads to excessive torsion at the knee. Torsion at the knee is not a good thing, often resulting in musculotendinous and articular strain or trauma.
The Standing Squat Test
To help identify if this is the case, you can use a simple clinical test called the standing squat. This dynamic movement evaluation helps you identify some kinetic clues as to where the criminals are, so you can better target your therapeutic interventions.
Simply have your patient stand with their feet shoulder-width apart and have them squat as low as they can without letting their heels come off the floor. Did they experience any discomfort? Did they look symmetrical, or did they shift to one side or the other? And if they did shift, did they shift right away or after about 45 degrees of hip flexion? All of these questions help to formulate your clinical hypothesis and build your criminal case.
Many practitioners are beginning to perform dynamic movement evaluations and think of the body as a whole. Let’s evolve our clinical practice to now starting to look for the mob bosses. This helps to answer the all-important question, “Why did the criminals behave the way they did?”
The standing squat test to help identify gluteal weakness causing internal femoral rotation and subsequent excessive torsion at the knee.In the case of looking at a patient presenting with knee pain, you have put them through the squat evaluation, as well as your other clinical examination strategies, and identified that they have weakness in the gluteal muscles leading to excessive femoral internal rotation. Through your physical evaluation, you may have identified trigger points locally in the muscles, as well as articular dysfunction to be treated accordingly.
But one of the most common mob bosses is lack of physical conditioning leading to an inability of the right muscles to do the right thing at the right time. This is extremely common in the gluteal muscles, and is often one of the main contributing factors surrounding knee pain and low back pain, including sacroiliac joint syndrome.
Gluteal Exercises to Help Support the Knee
One of the best ways to support patient care and eliminate the true cause of patients’ presenting complaints (the “mob bosses”) is through exercise. Exercise is one of the most discussed, yet misunderstood nonpharmacologic management strategies for musculoskeletal conditions. I personally believe there isn’t a single patient who couldn’t benefit from the targeted use of exercise. In our knee-pain scenario, exercise can help reinstate proper functioning to crucial muscles charged with helping the body perform the movements of life as efficiently as possible.
So, the next time you are treating chronic, recurrent knee pain and have identified the gluteal muscles as being deficient in their capacity, try prescribing gluteal strengthening exercises the patient can perform at home.
Great training exercises for the gluteal complex include the three-point lunge. This is a great exercise not only to work the gluteal muscles, mainly the gluteus medius and gluteus minimus; but also the quadriceps, including the vastus medialis. The three-point lunge also helps promote better balance and postural control when transitioning from one position to the next.
The gluteal bridge exercise helps activate the gluteal complex while minimizing compressive forces experienced at the knee.Unfortunately, the gluteus maximus doesn’t get enough stimulation with this movement to promote strengthening effects, so you can add a chair step-up to help elicit the proper muscle recruitment. If the patient is having difficulty with movements like the step-up due to knee pain, you can substitute with exercises such as the gluteal bridge with the feet elevated. This will help activate the gluteal complex while minimizing compressive forces experienced at the knee. Once the patient begins to develop the appropriate pelvic stability and you have successfully reduced the localized irritation, you can progress them to the step-up.
Exercise offers a significant advantage when combined with the therapeutic interventions you currently use. As with any of your techniques, therapeutic exercise can be manipulated to target the specific needs of your patients. The inclusion of therapeutic exercise as an intervention as well as looking at your presenting patients as a diagnosis detective, examining presenting injuries like they are crime scene, will provide you with a significant advantage in the quest to help your patients.
Sourced through Scoop.it from: circleofdocs.com
The knee is one of the largest joints positioned between two of the longest bones in the human body. The knee joint experiences immense transmission of forces each day and with weight- bearing action.
These canons of professional ethics are based upon fundamental principles of moral and professional behavior and recommended for all doctors of chiropractic and chiropractic assistants. The following basic principles should be guiding factors in the practice of chiropractic and upheld at all times:
Consider the well-being of the patient. The primary effort and ultimate goal is for the greatest good of our patients.
- Dr. Alexander D. Jimenez D.C., C.C.S.TChief Clinical DirectorPhone: 9155408444Email: email@example.comSpecializing in Severe Pain: Sciatica, Neck-Back Pain, Whiplash, Headaches, Knee Injuries, Sport Injuries, Dizziness, Poor Sleep, Arthritis. We use advanced proven therapies focused on optimal mobility, health, fitness, and structural conditioning. We use Patient Focused Diet Plans, Specialized Chiropractic Techniques, Mobility-Agility Training, Cross-Fit Protocols and the "PUSH System" to treat patients suffering from various injuries and health problems.
Message from: Dr. Alex Jimenez D.C., C.C.S.T
( Biography and my promise to you )
My name is Dr. Alex Jimenez, I am Chiropractic Doctor specializing in advanced therapies focused on total joint health, strength training and complete fitness conditioning. We use patient Focused Diet Plans, Advanced Chiropractic Techniques, Agility Training, Cross-Fit and the PUSH System to treat patients suffering from various injuries and health problems. Our goal too is to help your body heal itself naturally. When your body is truly healthy, you will arrive at your fitness level and proper weight efforlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25+ years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs...
My goal too is to help the body heal itself naturally. When your body is truly healthy and balanced, you will move pain free and ultimatly arrive at your optimal fitness levels and proper weight effortlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25 years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs. These programs are natural, and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life.
The focus on spinal and skeletal adjustments is what makes doctors of chiropractic unique in their approach to treating patients with spinal complaints. This hallmark chiropractic adjustment, however, is not the only procedure a chiropractor may employ in managing a patient's care. I am very proud to bring my patients a variety of treatment options beyond the typical scope of care. With the advances in physical therapies and modalities we bring El Paso option that better aid in the rehabilitation process. Tissue healing is a wonderful process that begins the moment an injury occurs. How the injury is managed determine the final outcome in terms of healing. It is critical we implement immediate procedures as soon as we can in order to gain optimal recovery. The old day of let it rest until it gets better is not the only option.
Letting it rest may even be an irresponsible approach considering what we now know. The implementation of active and movement based treatments have clearly shown increased and improved outcomes in many instances.
As a doctors focused on the greater good for a patient, we must assess each patient individually and apply the appropriate protocols. It is also very important to denote, that El Paso has fine doctors in many specialties of healing and repair. The direct relationship we have with specialist of these disciplines is clearly what allows us to bring the highest quality of care to our patients.
My promise to my patients is clear for all to read here. I, with Gods help, will do what ever it takes to assist you in your recovery. I too will draw upon all the specialist in this town to find you the collaborative care that is required with the disorders being tended to.
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Driven by the passion of doing what is in the best interest of the patient, I wake up every morning with the drive to help those in need. The claims process for health care is full of pits, valleys and difficult obstacles designed to strike fear in those in need. My duty is to do what is within the confines of the law, "what ever it takes" to get those involved to pay attention to those who need help. That is what I am honored to do for our patients.
Personally, I have seen great injustices transpire on those that do NOT have a voice. Whether, a language barrier or just not knowing the rules. My job is to find out how I can help. If I personally can not help, I will find the right sources to open the possibilities. I get the job done.
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- Mike ContrerasPersonal TrainerPhone: 915-203-8122Big Mike was born and raised in El Paso and is an excellent personal trainer and CrossFit coach. Mike works hand in hand with each patient’s clinical care plan in order to achieve optimal outcomes. A trusted clinical representative of the PUSHasRx System along with his advance protocols. Mike not only trains the injured and recovering. Mike is a sincere human that has great talent of brining out the best in every individual he works with. He will never admit it, but we will share with you a secret. He with his God given talents trains the greatest athletes and champions in El Paso. Many champions in our community know of his commitment. As a youth, he also played football (wide receiver), basketball, and track at Bel Air High School. Educated in Clinical Human Kinesiology at UTEP and loves playing football and basketball with his little nephews in his free time. Mike has three sisters and one brother, most of which live nearby in El Paso. When he’s not watching the Cowboys or Spurs play, he’s usually lifting, sleeping or watching movies. We are blessed to have this soul on our team.Read moreRead less
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- AndresRecovery & NutritionAndres has been at PUSHasRx for two years. He brought his company Recovery and became the official juicer. Andy will fix you right up. Andres, will make sure that your nutritional recovery programs fits within your standards. Also, there is great care in making sure the nutritional requirement are clinically met. Patients and high performance athletes depend on high performance nutritions. Upon your completion of the physical medicine portion of therapy you will be offered specialized organic recovery drinks and supplementation to help aid in your recovery. You will be confident that from your pushing to recovery, you will be taken care of.Read moreRead less
- Iylene AvalosPUSHasRx TrainerPhone: 915-203-8122ylene has been working with us for over 4 years. In her spare time she enjoys working out and running. She has 2 dogs and loves movies. Iylene is extremely aware of body mechanics and mindfully watches rehabilitation movements. She is always standing ready to assist and respond to client needs. Her commanding voice is always clear to all, no matter what floor you are on. Iylene is always ready and willing to answer any question you may have regarding fitness and recovery.Read moreRead less
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We've been blessed to use our methods with thousand of El Pasoans over the last 27 years. This has allowed us to improve health and restore true fitness through researched non-surgical methods and wellness programs. These programs are natural and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and informed on how to maintain this way of life.
As an extension to dynamic rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high performance exercises and advanced agility options. We are very proud to have teamed up with the cities premier therapist and trainers in order to provide high level competitive athletes the option to push themselves to their highest abilities within our facility.
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