Where There is Smoke, There is Fire


Being a Chiropractor and delivering patient care in our offices is incredibly fulfilling. You all have your share of “Chiropractic Miracle” stories and they only reaffirm our belief in the career path we have chosen. On a daily basis, you are working with your hands to help people live healthier lives.

No matter what type (or types) of technique(s) you practice, patients that come to see you can be broken down into presentation patterns. You used your examination, diagnostic and treatment skills to know how to take care of people with success. In fact, the longer you are practicing, the easier it becomes to spot the type of presentation patterns our patients walk in with.

It is always wonderful when the patient who comes in with neck or upper pain actually has the dysfunction contained within those areas. In other words, sometimes, “x” really does mark the spot and if it walks like a duck and talks like a duck, it really is.   Treating the area directly  with your modalities and adjustments will work very efficiently within a few visits. Simple! Done and over with!

Unfortunately, practice is not always this easy. In fact, more often than not, we get cases where the patients present with pain in a particular location but the major contributor comes from a related structures located distally. It’s the art of knowing when to look at body parts even if they are not in pain. That’s the big idea of this article. I want you to think outside the painful body part and see the big picture.


[quote_left]Sometimes it Seems Simpler Than It Really Is:[/quote_left]

Let me give you the 2 most common examples for the lower body that I see most frequently in the office. These are case types that are coming in at least once per week.


1.  A patient presents with classic, generalized lower back pain that can be chronic in nature and usually located in the lower lumbars. They can be male or female, young or old; they are all susceptible. Pain is mosltly localized, but it can be present in either sacroiliac joint and into the gluteal regions. They are either not sure how the pain began or they were doing something mundane like picking up a sock off the floor or making their bed.


The patient is astonished at how much pain they are in and how little they thought they did to cause it. Often they are confused and frustrated by having to take pain medication, anti-inflammatories or muscles relaxants. In some cases, the patient has had special imaging and find mild to no arthritis and/or normal to slightly bulging lumbar discs.


2. A patient presents with knee pain on the anterior portion, medial portion or both. They describe the pain as sometimes being deep in the joint, almost “under” the knee cap. Most of the time, these patients have not had any traumatic cause of injury and that is very perplexing to them.


They have gone to the allopathic physician who told them nothing is wrong and they should go see the physical therapist for help. Many are wearing ace bandages or knee braces that may or may not be helping. They have often already had special imaging and some have had their knees scoped, ACL’s replaced or a total or partial knee surgery.

In both of these cases patients can report reduced or cessation of certain physical activities due to the increasing pain. Pain can also worsen with any type of weight bearing activity.


[quote_left]The Patient Mindset:[/quote_left]

When these types of patients are coming in to you for help, try to remember their state of mind as they are sitting before you. Most of our patients have grown up going to traditional western medicine type practitioners. They have been told to only go to the Doctor when they are “sick” They have limited education of the body and are very focused on the painful area only.

You know better! You have the understanding that the biomechanics and the axial kinematic chain are vital components to a healthy body. It is our job to teach them how to understand their body and how the pain they are feeling is coming about. Just because pain is coming from one spot.


[quote_box_center]The Big Picture:[/quote_box_center]

Of course there is a portion or component of pain, which will actually come from the lower back or the knees themselves. This is why some of these conditions remit rather quickly with good old fashioned physiotherapy, adjustments and exercises at the targeted area.

But for many other types of pain that don’t seem to remit in a timely fashion, I want to remind you of the axial kinematic chain and how it affects everything in the lower body. Whenever you have lower back or any type of lower extremity pain, please go right down to the feet and examine them. How do you do that? Let’s give you a re-cap.

For most patients, the three arches in the plantar vault of the foot collapse or fall towards the floor. This foot drop then puts pressure on the distal tibia causing internal rotation. The inward rotation of the tibia creates a resultant inward rotation of the femur. Now the medial meniscus, medial collateral ligament and Anterior Cruciate Ligament of the knee are stressed.

This bony stress gives rise to soft tissue strain in the anteromedial knee region as a result.


Let’s finish following the axial kinematic chain up to the pelvis.  The inward rotation of the femur causes the pelvis to rotate anterior, translates forward and become unlevel, tipping down on the side of the inward femur rotation. Lateral curvature of the lumbar spine results along with muscle hypertension, limited ROM and pain.

Think outside the spine!

[quote_center]In case you forgot, these 5 indicators are quick ways of catching over pronation in your patient’s feet. The foot flare, dropped medial arches, bowing achilles tendons, lateral heel wear and medial patellae are all road signs along the axial kinematic chain that reinforce the negative patterns that will put stress on the lower extremity and the lower back.[/quote_center]

Not only do they help you identify what types of stress or biomechanical patterns are present but they allow you to educate your patients so they understand them as well.  These 5 Red Flags are time tested and incredibly reliable instruments of arch collapse that I and many others use on almost every patient that walks in the office.

Back pain is one of our bread and butter ailments that come in to our office. Let your knowledge and skills with your lower extremities help you do a complete job in catching all of the components that can be causing the patient’s pain. After all, we are more than just back doctors. We are specialists in the spine and the articulations of the spine. Let’s support our patients from the ground up!


Dr. Kevin Wong