Clinical Decision-making

Sports Management: Leg, Ankle, and Foot Injuries

By Frank M. Painter|April 23, 2013|Chiropractic Care, Chiropractic Education, Chiropractic Technique, Clinical Decision-making, Education, Gait Analysis, Rehabilitation, Sports Management|

Sports Management: Leg, Ankle, and Foot Injuries

The Chiro.Org Blog

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 27 from RC’s best-selling book:

“Chiropractic Management of Sports and Recreational Injuries”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 27: Leg, Ankle, and Foot Injuries

The lower leg, ankle, and foot work as a functional unit. Total body weight above is transmitted to the leg, ankle hinge, 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.

Injuries of the Leg

The most common injuries in this area are bruises, muscle strains, tendon lesions, postural stress, anterior and posterior compression syndromes, and tibia and fibula fractures. Bruises of the lower leg are less frequent than those of the thigh or knee, but the incidence of intrinsic strain, sprain, and stress fractures are much greater.

A continual program of running and jogging is typical of most sports. The result is often strengthening of the antigravity muscles at the expense of the gravity muscles — producing a dynamic imbalance unless both gravity and antigravity muscles are developed simultaneously. An anatomic or physiologic short leg as little as an eighth of an inch can affect a stride and produce an overstrain in long-distance track events.

Bruises and Contusions

The most common bruise of the lower extremity is that of the shin where disability may be great as the poorly protected tibial periosteum is usually involved. Skin splits in this area can be most difficult to heal. Signs of suppuration indicate referral to guard against periostitis and osteomyelitis.

Management. Treat as any skin-bone bruise with cold packs and antibacterial procedures, and shield the area with padding during competitive activity. When long socks are worn, the incidence of shinbone injuries is reduced. An old but effective protective method in professional football that does not add weight is to place four or five sheets of slick magazine pages around the shin that are secured by a cotton sock which is covered by the conventional sock. A blow to the shin is reduced to about a third of its force as the paper slips laterally on impact.

GASTROCNEMIUS CONTUSION

This is a common and most debilitating injury in contact sports. It is characterized by severe calf tenderness, abnormal muscle firmness of the engorged muscle, and inability to raise the heel during weight bearing.

Management. Treat with cold packs, compression, and elevation for 24 hr. Follow with mild heat and contrast baths. Massage is contraindicated as it might disturb muscle repair. The danger of ossification is less in the calf than in the thigh, but management must incorporate precautions against adhesions.

TRAUMATIC PHLEBITIS

Contusion to the greater saphenous vein may lead to rupture resulting in extensive swelling, ecchymosis, redness and other signs of local phlebitis. Tenderness will be found along the course of the vascular channel. During treatment, referral should be made upon the first signs of thrombosis.

Management. Management is by rest, cold, compression, and elevation for at least 24 hr. Later, progressive ambulation, mild heat, and contrast baths should be utilized. Progressive exercises may begin in 4-6 days. When competitive activity is resumed, the area should be provided extra protection.

NERVE CONTUSIONS (more…)

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Sports Management: Bone and Joint Injuries

By Frank M. Painter|April 15, 2013|Bone Injury, Clinical Decision-making, Diagnosis, Education, Joint Injury, Sports Management|

Sports Management: Bone and Joint Injuries

The Chiro.Org Blog

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 15 from RC’s best-selling book:

“Chiropractic Management of Sports and Recreational Injuries”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 15: Bone and Joint Injuries

In traditional general medical practice, the musculoskeletal system is the most overlooked system in the body, yet it comprises over half the body mass. The relationship between structure and function, and the interrelationship between all body systems, cannot be denied. Muscles, bones, and connective tissues are involved in both local and systemic pathology, and in a wide assortment of functional and referred disturbances. Thus, great care must be taken in eliciting the details of a complaint when any musculoskeletal disorder is suspected. This section reviews the basis of alert management of bone and joint injuries within the health care of athletic and recreational injuries.

Bone Injuries

Correlation of the history of the present complaint with musculoskeletal dysfunction must be done in detail and with care. Maintain accurate initial and progress records with repeated monitoring. Few patients can appreciate the relationship of dysfunction in one somatic part with a distant somatic part, let alone the relationship between a somatic dysfunction and a visceral dysfunction.

Background

Musculoskeletal symptoms may be the first clues toward poor structural adaptation or stress adaptation. The most common musculoskeletal symptoms are joint stiffness, joint swelling, and joint pain. Bones, being essentially nonyielding structures, are damaged when excessive force is applied directly or indirectly. The nature of the damage depends on the direction of the applied force on the bones and the manner in which these bones are attached to other structures. The principal acute skeletal injuries are sprains, strains, subluxations, fractures, and dislocations.

Normal bone has an excellent blood supply with some exception in the metaphyseal area; but tendons, ligaments, discs, and cartilage are poorly vascularized. Yet both bone and joints challenge the host’s defensive mechanisms. The pressure of pus under hard bone blocks circulation, and emboli and thrombosis can cause additional devascularization. When circulation is deficient, local phagocytic function and nutrition are deficient, and cure is stymied.

The most accurate diagnosis can be made immediately after injury, before swelling clouds the picture. Many fracture and dislocation complications such as nerve and vessel injury occur not from the trauma itself but from poor first aid which does not provide adequate splinting prior to movement. Traumatic bone injury rarely occurs without significant soft-tissue damage. The physical examination must be gentle but thorough because soft-tissue trauma is poorly visible on roentgenograms for several days after injury. For example, a working diagnosis of stress fracture may have to be made in the absence of classic symptoms by bony tenderness alone as the fracture may not be demonstrable on x-ray films for 10-14 days or longer.

Probing the History

Symptoms of a musculoskeletal nature that cannot be linked to trauma are suspect of a chronic organic process. Unfortunately, a history of stress or strain may not be remembered. Even severe trauma is easily put out of the mind uring a game when emotions are high or forgotten once the pain and swelling have left. Whether pain is present or not, the history must be probed to determine if the dysfunction is the result of bone, the joint, or the motor apparatus involved in the joint motion. (more…)

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The Horizontal Neurologic Levels

By Frank M. Painter|April 8, 2013|Chiropractic Care, Chiropractic Education, Clinical Decision-making, Diagnosis, Education, Evaluation & Management, Health Promotion, Neurology|

The Horizontal Neurologic Levels

The Chiro.Org Blog

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 4 from RC’s best-selling book:

“Basic Principles of Chiropractic Neuroscience”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 4: The Horizontal Neurologic Levels
and Related Clinical Concerns

This chapter describes the basic functional anatomy and clinical considerations of the horizontal aspects of the supratentorial, posterior fossa, spinal, and peripheral levels of the nervous system.

OVERVIEW

The reader should keep in mind that the various aspects of the nervous system as described in this manual (eg, longitudinal and horizontal systems) are only reference guides that are visualizations of a patient’s nervous system in the upright position. They can be likened to the lines of longitude and latitude on a globe of the earth.

Such systems do not exist physically, but they do serve as excellent mental grid-like tools (viewpoints) during localization and areas in which and from which relationships can be described. For example, although the longitudinal systems take a general vertical course within the spinal column there are numerous alterations and they actually become horizontal when decussating. While the horizontal levels are spatially placed in and extend from the CNS in a general segmental manner, they soon take a widely diffuse course as they project toward their destinations. Thus, references to longitudinal and horizontal levels are just general viewpoints.

It is helpful for study purposes to isolate the body into certain systems, as described above, organize systems into organs, organs into tissues, tissues into cells, and cells into their components. However, we should keep in mind that, physically and functionally, there is only one integrated body and it is more than the sum of its parts. And even the body cannot be thought of as truly separate from its external environment. Although we may do this for study purposes, it is a limited viewpoint.

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The Longitudinal Neurologic Systems

By Frank M. Painter|April 5, 2013|Chiropractic Education, Clinical Decision-making, Diagnosis, Education, Evaluation & Management, Neurology|

The Longitudinal Neurologic Systems

The Chiro.Org Blog

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 3 from RC’s best-selling book:

“Basic Principles of Chiropractic Neuroscience”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 3: The Longitudinal Neurologic Systems

This chapter succinctly describes the basic structure and function of the six major longitudinal systems; viz, the sensory, motor, visceral, vascular, consciousness, and cerebrospinal fluid systems.

As we begin this chapter, it might be well for the reader to subjectively grasp the significance of the motor and sensory systems as far as possible. One exercise in this is to imagine that you had become unconscious and someone has placed you in a remote dark empty cellar, far beyond any source of environmental sound. The first thing you realize is that you are a total sensory and motor paralytic from the neck caudad. You are unable to move even a fingertip because your motor system is not functioning. Because there is no feeling, you do not know whether you are recumbent or tied in a chair. Your vision is normal, but there is no light. Your hearing is normal, but there is no sound. Your taste buds are functional, but there is nothing to eat or drink. Your olfactory organs are functional, but there are no detectable odors. There is little left except thought and memory.

After a time in this predicament, thoughts undoubtedly arise such as, “I wish I had really looked at the beauty of the world when I had a chance. I wish I had listened to the music of the masters and even the birds in my backyard when I had a chance. I gulped down so many delicious meals. I had a beautiful garden, but I rarely took time to appreciate its design and fragrance. I even failed to take time to appreciate the texture of my own clothes. I was in such a hurry to go nowhere that was more important. I missed so much.”

OVERVIEW

The human nervous system is a marvel in organizing and adapting to internal and external environmental changes:

(1) The receptors and afferent neurons of the visceral and somatic input systems are necessary to detect internal and external environmental changes.

(2) The visceral efferent neurons and the muscles of the motor output system must be stimulated if action is to be taken.

(3) The integrative system serves as intermediary stations via a complex arrangement of interneurons whose synapses control impulse strength and signal direction from the sensory system to the motor system.

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Sports Management: Introduction to Sports-related Health Care

By Frank M. Painter|April 2, 2013|Chiropractic Care, Clinical Decision-making, Education, Sports|

Sports Management: Introduction to Sports-related Health Care

The Chiro.Org Blog

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:

“Chiropractic Management of Sports and Recreational Injuries”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 1: Introduction to Sports-related Health Care

If you were to ask the average coach about the responsibilities of an athlete, he would most likely reply that he or she was to conduct one’s self to the credit of the team, play fair, obey the officials, keep in training, be a credit to the sport, follow the rules, and enjoy the game: win or lose. This is the rhetoric commonly spooned to the naively inclined. If it were true, fewer sports injuries would be suffered.

With rare exception, even the Little Leaguer is commonly taught to WIN, drilled to disguise foul play from the eyes of the referees and umpires. Even in so-called noncontact sports, emphasis is often placed on getting the other team’s stars out of the game without causing injury to your own team. While conditioning is emphasized, the motivation is frequently on the preservation of a potential winning season rather than on prevention of a personal injury to a human being.

These words are harsh, but realistic. Yet, doctors handling athletic injuries must have a realistic appraisal of sports today if they are in good conscience to properly evaluate disability and offer professional counsel.

The Art of Evaluation

All people participating in vigorous sports should have a complete examination at the beginning of the season; and re-evaluation is often necessary at seasonal intervals. Re-evaluation is always necessary with cases where the candidate has suffered a severe injury, illness, or had surgery.

Evaluation begins with questioning. Because of drilled routine, any doctor is well schooled in the taking of a proper case history. But with an athletic injury, both obvious and subtle questions often appear. How extensive was the preseason conditioning? How much time for warm up is allowed before each game or event? What precautions are taken for heat exhaustion, heat stroke, concussion, and so forth? Does the coach make substitution immediately upon the first sign of disability for proper evaluation? How adequate is the protective gear? How many others on the team have suffered this particular injury this season?

Who, what, when, where, how, and WHY? These are the questions which must be answered before any positive course of health care can be extended. A detailed history of past illness and injury is vital. In organized sports, an outline of the regimen of training should be a part of the history, as well as a record of performance. Most sports will require a detailed locomotor evaluation of the player. Special care must be made in evaluating the preadolescent competitor because of the wide range of height, weight, conditioning, and stages of maturation. A defect may bar a candidate from one sport but not another, or it may be only a deterrent until it is corrected or compensated. Many famous athletes have become great in spite of a severe handicap.

The Physician’s Responsibilities (more…)

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Clinical Biomechanics: Mechanical Concepts and Terms

By Frank M. Painter|January 6, 2013|Chiropractic Care, Clinical Decision-making, Diagnosis, Education, Evaluation & Management, Spinal Manipulation|

Clinical Biomechanics: Mechanical Concepts and Terms

The Chiro.Org Blog

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 2 from RC’s best-selling book:

“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 2: Mechanical Concepts and Terms

All motor activities such as walking, running, jumping, squatting, pushing, pulling, lifting, and throwing are examples of dynamic musculoskeletal mechanics. To better appreciate the sometimes simple and often complex factors involved, this chapter reviews the basic concepts and terms involved in maintaining static equilibrium. Static equilibrium is the starting point for all dynamic activities.

Energy and Mass

Biomechanics is constantly concerned with a quantity of matter (whatever occupies space, a mass) to which a force has been applied. Such a mass is often the body as a whole, a part of the body such as a limb or segment, or an object such as a load to be lifted or an exercise weight. By the same token, the word “body” refers to any mass; ie, the human body, a body part, or any object.

Energy

Energy is the power to work or to act. Body energy is that force which enables it to overcome resistance to motion, to produce a physical effect, and to accomplish work. The body’s kinetic energy, the energy level of the body due to its motion, is reflected solely in its velocity, and its potential energy is reflected solely in its position. Mathematically, kinetic energy is half the mass times the square of the velocity: m/2 X V524. In a closed system where there are no external forces being applied, the law of conservation of mechanical energy states that the sum of kinetic energy and potential energy is equal to a constant for that system.

Potential energy (PE), measured in newton meters or joules, is also stored in the body as a result of tissue displacement or deformation, like a wound spring or a stretched bowstring or tendon. It is expressed mathematically in the equation PE = mass X gravitational acceleration X height of the mass relative to a chosen reference level (eg, the earth’s surface). Thus, a 100-lb upper body balanced on L5 of a 6-ft person has a potential energy of about 300 ft-lb relative the ground.

The Center of Mass

The exact center of an object’s mass is sometimes referred to as the object’s center of gravity. When an object’s mass is evenly distributed throughout, the center of mass is located at the object’s geometric center. In the human body, however, this is infrequently true, and the center of mass is located towards the heavier, often larger, aspect. When considering the body as a whole, the center of mass in the anatomic position, for instance, is constantly shifted during activity when weight is shifted from one area to another during locomotion or when weight is added to or subtracted from the body.

The term weight is not synonymous with the word mass. Body weight refers to the pull of gravity on body mass. Mass is the quotient obtained by dividing the weight of a body by the acceleration due to gravity (32 ft/sec524). Each of these terms has a different unit of measurement. Weight is measured in pounds or kilograms, while mass is measured by a body’s weight divided by the gravitational constant. The potential energy of gravity can be simply visualized as an invisible spring attached between the body’s center of mass and the center of the earth. The pull is always straight downward so that more work is required to move the body upward than horizontally (Fig. 2.1).

Newton’s Laws of Mechanics

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