ask glasgow chiropractic a question

Freephone 0808 143 5450 glasgow chiropractic spacerContributing to the health of the nation

foot pain image

Foot, Knee pain and Sciatica Research - Feet, knee pain and hips general overview - Foot, Knee and Leg pain in more detail - What can a chiropractor do for Foot, Knee & Leg pain?


Foot, Knee pain and Sciatica Research


Foot:

"Among a group of 30 patients with sprained ankles, researchers found that chiropractic ankle adjustments were superior to ultrasound therapy. Adjustment significantly reduced pain, increased ankle range of motion and ankle function."

OHU-(J Manipulative Physiol Ther 2001;24:17-24)


Knee:

"Following is a case study of a patient suffering from chronic knee pain after dislocating his knee playing football in 1968. Adjusting atlas only, the patient was relieved from his chronic knee pain."

Brown M, Vaillancourt P. Case Report: Upper cervical adjusting for knee pain. Chiropr Res J, 1993; 2(4):6-9


Sciatica:

"A study compared chiropractic care to bed rest, massage, electrical muscle stimulation, non-steriodal anti-inflammatory drugs (NSAIDS) and diazepam. Results revealed that patients who received chiropractic care showed a significant reduction in the length of care, swifter improvement in signs and symptoms, greater ability to continue working and significantly less worker disability than control subjects."

OHU-(Ann Swiss Chiro Assoc 1989;9:133-148)

"Manipulation of the spine shows promise for relief of symptoms [of spinal stenosis] through improving spinal biomechanics."

OHU-(JMPT 2000;24:300-4)


Foot, knee and Hip Pain Overview


If you’ve ever thought that your chiropractor is there just to treat your back- then think again. Chiropractors are trained to look at the whole body, and they aim to understand how the spine relates to other parts of the body, particularly the hips, knees and feet.


Because the lower extremities support the spine through the pelvis, they will influence its mechanics, the way the pelvis stands and behaves. This will be all the more relevant if the symptoms are particularly worse when standing and/or walking. Because of this, chiropractors are particularly interested in the well-being of the feet and legs. The latter are designed to carry the body above and to provide movement while keeping the spine and pelvis in balance. These tasks are very demanding and require strength as well as agility. For these incompatible reasons, problems will occur and come within the field of chiropractors. Below we detail some of the problems commonly found in the lower limbs.


Feet and ankles

Ankle instability

foot pain

Who has not twisted their ankle at some stage in their life? If you have, then you might still have some weakness, which could still be causing problems. The most common injury to the ankle is turning it in, such as when wearing high heels and turning it over by stepping on a stone or edge of a kerb. This is the common ankle sprain. Occasionally the end of a bone on the outside of the ankle breaks. Most often, the ligaments of the ankle on the front and side get torn and produce massive swelling and bruising. It usually takes 4 to 6 weeks to recover from the immediate injury. However, the ligaments very rarely repair satisfactorily and often become full of scar tissue which is not elastic. For this reason it is very common to roll the ankle over again and sprain it several times after the initial injury. Such repeated traumas will influence the mechanics of the ankle and cause some insult to the joint and the structures above such as the knee and spine. These usually tend to become obvious after jogging or long walks. Because the symptoms may not be in the ankle but in some distant joint, you do not necessarily think of that old ankle injury being the origin of it. Your chiropractor will, by careful case history and examination, be able to discover the possibility of this cause and remedy it accordingly.


Pronation

This is a weakness of the feet and often produces distortion such as flat feet, bunions, hammer toes and widening of the forefoot. Although pronation is often a consequence of ankle instability, it can happen on its own through various other factors such as prolonged standing, bad shoes or inherited tendencies. Much is now known about foot pronation and many chiropodists or podiatrists specialize in its correction. The most important factor however is to recognize the condition and your chiropractor is ideally suited to diagnose the problem. Your chiropractor may offer to correct the problem or may refer you to a podiatrist. She/he will also advise you on correct shoe wear and on the right type of exercise which will not strain your feet or make the condition worse.


Knees

The knees have the most unbelievable task of bending through 180 degrees between the two longest bones of the body and yet have very little support from the muscles (unlike the hip joint). For this reason, they rely on strong ligaments to keep the two bones together and the cartilages (menisci) to make them fit tightly together when the knee is fully extended. The wide range of movement means that the knee will be prone to wear an tear both at the kneecap and at the main joint (arthritis). When the knee starts to bend, the slackening of the ligaments makes the cartilages vulnerable to trauma. This is the main reason why footballers have so many knee injuries.


Arthritis is by far the most common problem of the knees and cannot be reversed. However, a good understanding of the mechanical strain on the knee can help us reduce the discomfort from it. This could come from the foot and ankle or the pelvis and the hip. Your chiropractor is well equipped to discover the pattern and advise you accordingly.


The cartilages are there to give strength to the knees. If they become injured, the knee will not be so strong but unfortunately, any loose bit must be removed to avoid worsening the condition. Recent surgical advances such as arthroscopy offer an invaluable help damaged cartilages. But again, improving the mechanics and support to the knee with chiropractic care will ensure maximum strength and support and help prevent further deterioration.


Hips

The most common affliction of the hips is arthritis. Early signs include stiffness in the groin and occasional sharp pain on some movements. These can exist for years and not be recognized as the early signs of an impending wear which can be precipitated by a variety of factors: prolonged weight-bearing, excessive strain when young (gymnastics), weakness at birth or during youth and others. A tight hip will also produce an unequal walking pattern and bring on possible pain in the lower back. Your chiropractor will recognize this pattern and be able to treat and advise you accordingly. This could delay the necessity for a hip replacement which most of us will want to delay for as long as possible.


Chiropractic management

There are many other problems of the lower extremities that are not mentioned here. Your chiropractor specializes in the mechanics of the bony frame and recognizes these problems readily. His expertise in the field of joint problems places him in an advantageous position to give you appropriate care and advice. He looks at the interaction of all the joints of the leg and pelvis and understands how they affect each other. He will probably try to correct the problem by conservative means first, in other words, by ways that do not involve surgery. But if your problem cannot be helped by gentler means, then more drastic measures such as a surgery will be discussed. In any situation, your chiropractor is probably the best person to call on first if you suspect your problem to be one involving bones and joints not working properly.


Knee pain in more detail


Knee pain can be caused by various factors, not always originating from the knee.


Common causes of pain

  • local causes- Trauma and overuse
  • Dysfunction of lower limb
  • Referred pain from lower back, pelvis and hip.

Ligament Injury


The knee joint is a complex joint that relies heavily on ligaments and muscles for stability. When pain is perceived as coming for the knee all the anatomical components need to be examined in addition to the joint, i.e. low back, pelvis, hip and ankle/foot.


Ligaments are usually injured due to direct trauma to the knee and the amount of ligament injury caused is described as 1st, 2nd or 3rd degree sprain.


1st degree sprain- some tearing/overstretch of the fibres, no joint instability, mild pain, minimal swelling.


2nd degree sprain- separation/tearing of fibres causing moderate instability and moderate to sever pain, swelling and stiffness.


3rd degree sprain- total rupture, gross instability, serve pain, swelling, usually requires length immobilisation and/or surgery.


Ligament injury will usually involve a certain amount of swelling directly over the ligament.


Most common causes of ligament sprain are:


Posterior cruciate ligament- football tackles


Anterior cruciate ligament- sudden slowing down i.e. sport


Collaterals - injury from the side of the knee while foot in planted on the ground.


Treatment of the sprain depends on the degree of injury. Chiropractors can treat 1st and 2nd degree sprains but 3rd degree sprains often require surgical repair.


Conventional treatment of 1st and 2nd degree sprains involve:

  • Rest
  • Ice
  • Compression/elevation
  • Ultrasound/interferential
  • Soft tissue work
  • Nutritional support of vitamin C and zinc.
  • Gradual introduction of mobilisation/ exercises and strengthens the muscle
  • Followed by proprioceptive training once ligament has healed.

Grade one sprains are often weight bearing within one week whereas a grade two sprain commonly takes 3-6 weeks before person can return to normal activities.


Cartilage Dysfunction

Chondromalacia patella describes inflammation/irritation of the knee joint together with destruction of the cartilage that lies underneath the knee cap. Pain is usually at the front of the knee and is worse on going up and down steps and having the knee bent for long periods of time. There is often associated grating of the joint. Its causative factors include; patella malalignment, increased activity such as running, direct trauma i.e. fall onto bent knee, repetitive trauma i.e. kneeling, weak muscles and flat feet.


Treatment- Rest and use of cold packs, muscle rehabilitation, adjusting of the pelvis, hips, knee and feet and prescribing of formthotics if required. If patients have not responded with conservative treatment within 6 months then they may be referred for surgery.


Osgood Schlatters

This is a common condition found in adolescence as the muscles are stronger than the bones prior to bone fusion. It is caused by overuse of the knee resulting in inflammation. Usually affects active individuals i.e. runners and those playing on hard surfaces.


Symptoms - Pain and tenderness over the tibial tubercle, pain on full knee bending, redness and heat and a hard swelling at the site.


Treatment- If there is no separation, with rest and use of modalities to reduce the swelling, this condition is self-limiting with no long term after effects.


Degenerative Joint Disease

The knee is a very common site for wear and tear arthritis. Usually in the over 40 year olds and presents as swelling, joint line pain, decreased range of movement, grating of the joint, muscle wasting, increased muscle tone possible limp and feeling of giving way. The diagnosis is aided with an x-ray.


Treatment- reducing the joint inflammation, restoring any abnormal biomechanics i.e. form flat feet, adjusting of the low back, pelvis, hip, knee and feet, soft tissue of the involved muscles and advice on non-weight bearing exercises such as cycling and swimming. Early chiropractic intervention can help to reduce the progression and severity of the arthritis.


Flat Feet

The feet have two arches one on the inside and one of the outside of the foot allowing for correct propulsion. We are used to wearing shoes on even surfaces and therefore the arches of the feet do not get used for shock absorbance. This results in the muscles weakening and eventual dropping of the arches. This causes the knees to become mildly "knock kneed", putting more pressure on the inside joint of the joint of the knee (one of the causative factors of arthritis and cartilage problems)


Treatment- An assessment by the chiropractor will determine if the arches have dropped. If they have, this can be addressed by exercises to strengthen the muscles and use of arch support.


Referred pain from the low back, pelvis, hip, knee pain can also be referred form the low back, usually from the joint irritation from the second and third lumbar vertebrae, from irritation of the sacro-illiac joints of the pelvis and from the hip. There are orthopaedic tests that the chiropractor will perform in order to determine the origins of the knee pain. There may well be multiple causes of the knee pain.


Knee pain is often difficult to pin point the origin of and can be difficult to treat as often the patient is unable to rest it sufficiently. However with correct treatment the most common of the knee complaints can be treated, by the chiropractor and the patient.


Foot pain in more detail


Have you ever wearily returned from a hard day at work to discover that you ache all over? Do you find that not only your feet hurt but also your lower back? Have you now started to complain of knee or hip pain that has no particular reason for its onset?


How can your feet affect your knees, hips and spine?

Your feet are composed of bones, joints, muscles, ligaments, tendons, nerves and blood vessels. The surrounding ligaments and muscles provide support for all the joints of the foot and ankle. They also stabilise the foot while walking. Most importantly for the knee, a hip, spine and pelvis, the foot absorbs shock. Both the foot and ankle must provide shock absorption while at the same time balance the body. They must be able to adapt to varying terrain. They support your body weight and make it possible to walk, run, stand and jump. Therefore, dysfunction at the feet may have serious, consequences for other neighbouring joints and the entire spine.


What causes foot problems?

Foot pain can be due to inappropriate footwear, which lacks support or due to ill-fitting shoes. Any injury especially to the hip, knee, foot or ankle that results in an inability to walk correctly or that results in a limp will also have consequences for the entire spine. Sports injuries, stress fractures to the bones in the foot and recreational overuse can result in compensation in the knee, hip, spine and pelvis.


How can foot problems endanger other regions of the body?

Foot pain can cause you to modify the way you walk, which in turn, places significant stresses on the knees, hips, spine and pelvis. Your body has to compensate and this can lead to limited movement in other regions of the skeleton. Some of the more common problems seen in practice include: plantar fascitis; hallux valgus; pain under the metatarsal joints; heel spur; arch collapse; Achilles tendonitis; recurrent ankle sprain and shin splints.


Absolutely anybody can suffer from foot disorders during the course of their lifetime. Overweight individuals, diabetics, gymnasts, athletes and dancers are more susceptible to foot problems as they place huge demands on their feet.


foot pain

Gymnasts and dancers are prone to stress fractures and ligamentous/muscular sprain/strain injuries due to their extreme flexibility and ability to move their joints beyond their normal range of motion. Athletic patients must examine the wearing pattern on their training shoes as this may provide clues to various foot deformities. Excessive wear on the outside heel, together with a caved-in appearance of the inside of the shoe would suggest pes planus, or more commonly known as fallen arches/flat foot. The shoe should also be checked for flexibility and shock absorption. The fit of the shoe is also important as it must provide support to the arches and allow sufficient toe room.


What is chiropractic?
foot pain

Chiropractic is the third largest healthcare profession in the western world after medicine and dentistry. The word "chiropractic" is derived from the classical greek and means "done by hand", or manipulation. Chiropractors specialise in diagnosing and treating disorders of joints, muscles, bones, ligaments and tendons. They pay attention to the spine, as its close relationship to the nervous system can result in head, arm, and trunk and leg pain, numbness or pins and needles.


Orthotics (shoe inserts)
foot pain

If you are plagued by recurrent foot pain and/or dysfunction, you should consult a chiropractor. Your chosen chiropractor will take a thorough case history; employ a vast number of orthopaedic and neurological diagnostic tests; assess your gait and examine the range of movement in the joints of your feet and ankles.


By employing such a thorough investigation of your foot complaint your chiropractor will identify what is causing your pain and determine the best method of treatment. Your chiropractor will also examine your knees, hips and spine, which may have been affected by your foot complaint. Chiropractors have experience in relieving such pain and preventing it from causing even more problems in other areas of your body.


How can chiropractic help?

Your chiropractor may recommend orthotics to help solve some of your foot problems. Custom-made, flexilile orthotics may be employed in addition to foot and spinal adjustments and prescribed exercise. The need for orthotics is most crucial for patients with knee, foot or ankle disorders that impact on their spine or pelvis. The use of orthotics will often complement and improve the chiropractic adjustment, while assisting the body to return to an improved state of function and health.


Sciatica in more detail


What is sciatica?

Sciatica is not a disease, but the name given to a sharp pain in the area of the sciatic nerve. On each side of the lower back, a series of nerves branch off to different parts of the lower body. The largest, the sciatic nerve, runs down each leg. When back problems put pressure on this nerve, the result is pain in the lower back, buttocks, hip, and back of the leg and possibly all the way down to the toes.


The sciatic nerve may become irritated when the inner part of the shock absorbing discs between the bones bulge out into the space where the nerve starts. This is called a protrusion and if it bulges out too much, disc prolapse or rupture could occur. This puts even more pressure on the spinal nerves, resulting in sciatica.


Sciatica has many other causes, including tight hamstrings, tight buttock muscles, joint and muscle problems in the spine or pelvis, different leg lengths, and back sprain.


Who does it affect?

Men may experience sciatica more than women due to the hact that many men carry their wallets in a hip pocket, the exact spot where the sciatic nerve is located in the buttocks. Sitting on the wallet can cause pressure on the nerve and sciatic pain.


What are the symptoms?

The pain may be burning, tender, sharp, shooting, dull feeling, "pins and needles", or an electrical sensation and usually occurs on one side of the buttocks and/or leg.


How can it be prevented?

Prevent sciatica by avoiding sitting in one position for prolonged periods and follow a regular exercise programme that includes gentle stretching exercises, such as yoga. Men should eliminate unnecessary items from their wallets and not carry them in hip pockets!


Practise good posture, and check your sleeping position. Sleep on your back with a pillow under your knees, or on your side with a pillow between your knees. Ensure that your pillow is the correct height-not too low or too bulky.


Finally, prevent the problem from occurring in the first place by keeping to your maintenance chiropractic appointments. Chiropractic treatment can keep your spine healthy, and consciously remind you to promote your health. You can do this also by maintaining a healthy weight and incorporating deep breathing to reduce stress which helps relax tense muscles. Have your shoes professionally fitted to avoid aggravation of back pain. Your chiropractor can recommend furniture and other products that encourage back support.


Treatment

Depending on the type and cause of your sciatica, the following self-help treatments may be used, but remember- don’t delay your treatment-early arthritic changes can occur rapidly in injured joints!

  • 1. Initially try bed rest. Use a firm mattress, lie on your unaffected side with your unaffected leg slightly bent, and your affected leg straight and supported by pillows.
  • 2. Try applying ice packs for 15 minutes a few times a day. Do not apply ice directly to the skin. Don’t use heat as it can slow your recovery.
  • 3. Exercise to loosen up! Lots of muscle will get tight-stretch that back, buttocks, hamstrings, buttock muscle and calf. Consider varying your training, and when the pain diminishes, try a gentle walk. However, if a specific exercise causes severe pain, avoid it!
  • 4. Avoid long periods of sitting which can aggravate sciatica, and make sure your sitting posture is correct (especially at work and in the car) and use pillows if needed to adjust your back and buttocks into a more comfortable position. Avoid sitting on soft chairs and sofas.
  • 5. Finally if sciatica does not respond to self care within two weeks, consult your chiropractor for an examination, treatment and advice. Call sooner if numbness or pain increases, or if the foot becomes weak.

By using gentle nut specific adjustments, chiropractors are able to release the nerve and address the often underlying problem.


Contact your general practitioner immediately for any loss of bowel or bladder function.


Extra tips for sufferers

  • When sciatic pain is caused by a bulging disc in the lower back, it is often made worse by bending, straining, coughing or sneezing. The lower part of the back feels stiff loses its curve and the muscles along each side of the spine may go into painful spasm. So avoid coughing and sneezing in a bent position.
  • Avoid continuous bed rest for a prolonged time which slows recovery.
  • When standing for some time, place one foot higher than the other on a block to transfer your weight.
  • When shopping move purposefully to your destination- ambling is often more painful.

What can Chiropractors do for Foot, knee or leg pain?


Your chiropractor will perform a complete consult and examination and may take radiographs (x rays). After review of the examination findings your chiropractor will recommend an appropriate and individual care program. Treatment consists of specific manual adjustments, to the individual joints of the body and spine, which restore damaged neurologic function.