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DR. CHARRETTE’S ADJUSTING SEMINAR

3 FACTS ABOUT FEET

▸  1. The most common subluxation pattern of the foot is excessive pronation

▸  Nearly all excessive pronation is BILATERAL but ASYMMETRICAL

▸  2. Most foot subluxations do not create foot SYMPTOMATOLOGY

▸  3. Whatever one arch in the foot does….so do the other two

4 GLOBAL POSTURAL DISTORTIONS COMMONLY FOUND TOGETHER

▸  1. Bilateral/Asymmetrical Foot Pronation

▸  2. Pelvic Tilt

▸  3. Anterior Translation of Pelvis

▸  4. Anterior Translation of Cervical Spine

PELVIC TILT = PRONATION

▸ Unilateral pronation or asymmetrical bilateral pronation has the effect of producing pelvic tilt, OR the unloved pelvis may

cause the pronation

▸  Harrison D., et. al. (1988) CBP Vol.IV., CBP Inc.

THE “NOISY JOINT”

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PROPRIOCEPTION MECHANORECEPTORS

Provide continuous feedback about where the body is in space Position sensitive Motion sensitive

Vibration sensitive Pressure sensitive Thermo sensitive Chemo sensitive

Inhibit perception of pain

TYPES 1,2,3 MECHANORECEPTORS

ADAPT

TYPE 4 MECHANORECEPTORS

DO NOT ADAPT

NOCICEPTORS NOCICEPTORS

▸ “A continuous tridimensional plexus of unmyelinated nerve fibers….and weaves (Like chicken-wire) in all directions.”

▸  Wyke B. Neurological Aspects of Pain Therapy. In: Swerdlow M, Editor. The Therapy of Pain. Philadelphia: JB Lippencott: 1980

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NOCICEPTOR LOCATION

▸  Grieve G. Common Vertebral Joint Problems

‣ Skin ‣ Subcutaneous tissue ‣ Adipose ‣ Joint capsules ‣ All spinal segments ‣ Blood Vessels ‣ Cancellous bone

‣ Periosteum ‣ Muscles ‣ Tendon ‣ Fascia ‣ Aponeurosis ‣ Dura Matter ‣ Epidural Tissue

WHAT ARE THE NOCICEPTORS IN YOUR WRIST/FOOT DOING RIGHT NOW THAT THEY WEREN’T DOING WHEN YOUR WRIST WAS IN A MORE

NEUTRAL POSITION? __________________

WHAT ARE THE NOCICEPTORS IN YOUR WRIST/FOOT DOING RIGHT NOW THAT THEY WEREN’T DOING WHEN YOUR WRIST WAS IN A MORE

NEUTRAL POSITION?

EXCESSIVELY FIRING

WHAT IS THE FINAL DESTINATION OF THE NOCICEPTIVE IMPULSES, CREATED IN YOUR WRIST/FOOT, IF THEY ARE NOT INHIBITED?

__________________

WHAT IS THE FINAL DESTINATION OF THE NOCICEPTIVE IMPULSES, CREATED IN YOUR WRIST/FOOT, IF THEY ARE NOT INHIBITED?

SENSORY CORTEX

IF THE NOCICEPTIVE IMPULSES FROM YOUR WRIST/FOOT WERE NOT INHIBITED AND THE

IMPULSES ELICITED AN ACTION POTENTIAL IN THE SENSORY CORTEX, WHAT IS THE CONSCIOUS

SENSATION THAT ONE WOULD FEEL CALLED? __________________

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IF THE NOCICEPTIVE IMPULSES FROM YOUR WRIST/FOOT WERE NOT INHIBITED AND THE

IMPULSES ELICITED AN ACTION POTENTIAL IN THE SENSORY CORTEX, WHAT IS THE CONSCIOUS

SENSATION THAT ONE WOULD FEEL CALLED?

PAIN

2 THINGS NOCICEPTORS DO 1. Initiators of Pain 2. _______________

WHAT INHIBITS NOCICEPTIVE IMPULSES?

THE FIRING OF TYPE 1,2,3

MECHANORECEPTORS

“RESTRICTED JOINT MOTION CAUSES AN INCREASE FIRING IN NOCICEPTIVE

AXONS….AND A DECREASE IN FIRING OF LARGE DIAMETER MECHANORECEPTOR AXONS.”

▸  Hooshmand H. Chronic pain: reflex sympathetic dystrophy, prevention and management. Boca Raton, FL CRS Press: 1993. p. 33-35

WHERE DOES THE INHIBITION OF NOCICEPTORS BY TYPES 1,2,3 MECHANORECEPTORS OCCUR?

AT A LEVEL OF THE SPINAL COLUMN

HOW MANY IMPULSES REACH THE SENSORY CORTEX EVERY SECOND?

3 TRILLION

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HOW MANY OF THE SENSORY IMPULSES THAT BOMBARD THE SENSORY CORTEX EVERY SECOND

ARE CONSCIOUS IMPULSES? PAIN IS A CONSCIOUS SENSATION.

__________________

▸  Furman and Gallo, 2000. The Neurophysics of Human Behavior.

HOW MANY OF THE SENSORY IMPULSES THAT BOMBARD THE SENSORY CORTEX EVERY

SECOND ARE CONSCIOUS IMPULSES? PAIN IS A CONSCIOUS SENSATION.

50

▸  Furman and Gallo, 2000. The Neurophysics of Human Behavior.

“A CLEAR INDICATION THAT USING CONSCIOUS PERCEPTION OF PAIN TO DETERMINE THE NEED FOR CARE IS

HUGELY INADEQUATE AND INACCURATE.”

▸  Chestnut, James L., The 14 Foundational Premises For the Scientific and Philosophical Validation of the Chiropractic. Wellness Paradigm. P. 58, 2001.

NOCICEPTOR ACTIVITY REFLEXIVELY ACTIVATES THE

SYMPATHETIC NERVOUS SYSTEM….

▸  Kabell J. Sympathetically maintained pain. In: Willis W.ed. Hyperalgesia and Allodynia. Raven Press. NY: 1992

“….NOCICEPTIVE INPUT….CAN CAUSE SYMPTOMS SUCH AS SWEATING, PALOR, NAUSEA, VOMITING, ABDOMINAL PAIN,

SINUS CONGESTIONS, DYSPNEA, CARDIAC PALPIATIONS, AND CHEST PAIN…”

▸  Nansel D. Szlazak M. Somatic Dysfunction and the phenomena of visceral disease stimulation: A probable explanation for the apparent effectiveness of somatic therapy in patients presumes to be suffering from visceral disease. J. Manipulative Physiol There 1995: 118:379-97.

“ADJUSTMENTS TO DECREASE NOCICEPTOR INPUT TO THE SPINAL CORD SEEM TO BE AN EFFECTIVE WAY TO DECREASE “THE

HYPEREXCITABLE CENTRAL STATE.”

▸  Patterson M. The spinal cord: participant in disorder. J Spinal Manip: 1993: 9(3) 2-11.

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2 THINGS NOCICEPTORS DO 1. Initiators of Pain 2. Reflexively activate the

sympathetic nervous system

LOWER EXTREMITY ADJUSTMENTS

ANKLE/FOOT

INDICATORS OF EXCESSIVE PRONATION

▸  1. Foot Flare/Toe Out

▸  2. Posterior/Lateral Heel Wear

▸  3. Patellar Approximation - “Knock Kneed”

▸  4. Achilles Tendon Bowing

▸  5. Dropped Navicular/ Flat Arch/ Pes Planus

▸  6. Callouses on 2-3-4 Metatarsal Heads

▸  7. Positive Navicular Drop Test (PSI)

▸  8. Non-Grade 5 Psoas, Gluteus Medius, Quadriceps

PLANTAR GAIT PATTERNS

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EXCESSIVE PRONATION - SUBLUXATION PATTERN BONES SUBLUXATION DIRECTION

Navicular Inferior & Medial

Cuboid *Superior & Lateral (or Inferior & Lateral)

Cuneiforms Inferior

Metatarsal Heads 2-3-4 Inferior Metatarsal Heads 1 & 5 Superior & Lateral/Medial

Talus Mostly Anterior & Slightly Lateral Calcaneus Everted & Plantar Flexed

Fibular Head Posterior & Lateral

EXCESSIVE PRONATION SUBLUXATION PATTERN

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LOWER EXTREMITY SUMMARY

NAVICULAR

CUBOID THE “MONEY ADJUSTMENT”

CUNEIFORMS

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METATARSAL HEADS

TALUS

CALCANEUS

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FIBULAR HEAD

ASSOCIATED ADJUSTMENTS

HALUX VALGUS ADJUSTMENT HEEL SPUR ADJUSTMENT

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INTERPHALANGEAL ADJUSTMENT

KNEE

5 IMPORTANT POINTS/RULES ▸  1. Apply the proper pressures.

▸  Pressure Hand: 55-75 lbs (NON-DOMINANT HAND)

▸  Speed Hand: 2-5 lbs (DOMINANT HAND)

▸  TOTAL: 60-80 lbs minimum

▸  2. DO NOT TORQUE.

▸  3. DO NOT REBOUND.

▸  4. Apply Pressure evenly from thumb to the little finger on pressure hand.

▸  5. The elbows ARE NOT involved.

RIGHT HAND DOMINANT

PRESSURE HAND ▸  Put #14 Fingertip on thumb of non-dominant hand

▸  Proximal Phalanges and thumb pad make single flat surface

SPEED HAND ▸  On Dominant Hand,

cross thumb pad over DIP of index finger

PRESSURE HAND ▸  Thumb pad on contact point

▸  Even pressure over entire area

SPEED HAND ▸  Tumb points toward doctor

▸  Speed thumb pad on pressure thumbnail

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PRESSURE

▸  Roll speed thumbnail toward pressure hand

▸  Pressure hand applies 55-75 lbs of pressure

▸  Speed hand applies 2-5 lbs of pressure

SET UP

▸  Place knee on table so lateral thigh is parallel to forearm of speed hand

THRUST

▸  Apply appropriate pressures with hands

THRUST

▸  Apply appropriate pressures with hands and extend wrist as quickly as possible

▸  Stop the thrust abruptly by striking forearm against lateral thigh

KNEE INDICATORS MEDIAL CONDYLE - 10%

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LATERAL CONDYLE - 45% POSTERIOR CONDYLE - 45%

CONTACT POINTS

▸  Upper Middle portion of condyle

▸  Medial Condyle - Medial Rotation

▸  Lateral Condyle - Lateral Rotation

▸  Both Condyles - Posterior Tibia

HIP

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PROPRIOCEPTIVE TAPING OF THE FOOT

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WRIST

TYPICAL CARPAL/WRIST SUBLUXATION PATTERN

BONES SUBLUXATION DIRECTION

Scaphoid Posterior & Medial

Triquetrum Posterior & Lateral

Lunate Anterior

Carpal-Metacarpal Lateral

Radius-Ulna Radius - Lateral, Ulna - Medial

Proximal Row of Carpals Superior

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Posterior Lateral Posterior Medial

Anterior

Triquetrum

Lunate

Scaphoid

INDICATOR ANTERIOR DEPRESSION OF LUNATE

SCAPHOID

SCAPHOID ▸ TRACTION - Inferior ▸ EXTEND TO TENSION - No more than 30

Degrees ▸ THRUST P to A - Without winding up or

recoiling

TRIQUETRUM

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TRIQUETRUM ▸ TRACTION - Inferior ▸ EXTEND TO TENSION - No more than 30

Degrees ▸ THRUST P to A - Without winding up or

recoiling

LUNATE

LUNATE ▸ TRACTION - Inferior ▸ EXTEND TO TENSION - No more than

40 Degrees ▸ PULL A to P - Without flexing the wrist

RADIUS-ULNA

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TRACTION AND SQUEEZE

1ST CARPAL-METACARPAL

“SCOOP” LATERAL TO MEDIAL

PROXIMAL CARPALS

CARPAL SPREAD

DISTAL CARPALS

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DISTAL ROW DISTRACTION

WRIST TAPING

ELBOW

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RADIUS

ULNA (MOSTLY MEDIAL, SLIGHTLY POSTERIOR)

SHOULDER SHOULDER SUBLUXATION PATTERN

JOINT SUBLUXATION DIRECTION

Glenohumeral Joint Humeral Head Anterior

Acromioclavicular Joint Distal Clavicle Superior

Sternoclavicular Joint Proximal Clavicle Anterior & Medial

Scapulo-thoracic Joint Fixation/Hypomobile

First Rib Anterior

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GLENOHUMERAL JOINT

ACROMIOCLAVICULAR JOINT

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STERNOCLAVICULAR JOINT

SCAPULO-THORACIC

TRIGGER POINT #1 - SUBCLAVIUS TRIGGER POINT #2 - MID-SCAPULA

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TRIGGER POINT #3 - TERES ATTACHMENTS TRIGGER POINT #4 - LEVATOR SCAPULAE BELLY

TRIGGER POINT #5,6 - LATERAL DELTOID TRIGGER POINT #7 - ANT/MED HUMERAL HEAD

TRIGGER POINT #8 - POST/MED HUMERAL HEAD TRIGGER POINT #9 - SUBSCAPULARIS BELLY

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LEVATOR SCAPULAE TENDON