Anterolateral Lower Leg Pain &/or Foot Drop – Peroneal Nerve Entrapment – A NYC Chiropractor /Applied Kinesiologist /NeuroKinetic Therapist Explains

Occasionally a patient comes in with pain along the anterior lateral part of their lower leg and they may also have difficulty lifting the top of their foot upward at the ankle (dorsiflexion) or moving the foot outward at the ankle (eversion). This also affects the patient’s gait (ability to walk properly)

movements-of-foot

They may have been told that their problem is sciatica since branches of the sciatic nerve goes all way down the leg and into the toes. They may have been to a physical therapist or another chiropractor who worked on the low back where the sciatic nerve originates without any relief.

How a NYC Chiropractor /Applied Kinesiologist /NeuroKinetic Therapist Treats Sciatica

But the problem is the peroneal nerve which branches off the sciatic just below the knee; it goes from the common peroneal nerve which starts at the lateral back of the knee near the inner side of the biceps femoris  (part of the hamstings), goes to the back of the fibula bone and then branches off to the superficial peroneal nerve and the deep peroneal nerve.

The deep peroneal nerve innervates the muscles of the anterior compartment of the leg which are: tibialis anterior, extensor hallucis longus, extensor digitorum longus, and the peroneus tertius. Together these muscles are responsible for dorsiflexion of the foot and extension of the toes.

The superficial peroneal nerve passes between the peroneus muscles and the extensor digitorum longus, and goes into the deep fascia at the lower third of the leg; it supplies the muscles of the lateral compartment of the lower leg : peroneus longus and peroneus brevis. These assist with eversion and plantar flexion of the foot.

The deep peroneal nerve passes inferior and medially, deep to extensor digitorum longus,  and comes into relation with the anterior tibial artery above the middle of the leg; it then descends with the artery to the front of the ankle-joint, where it divides into a lateral and a medial branch. The deep peroneal nerve innervates the muscles of the anterior compartment of the leg which are: tibialis anterior, extensor hallucis longus, extensor digitorum longus, and the peroneus tertius. These muscles are responsible for dorsiflexion of the foot and extension of the toes.

superficial-and-deep-peroneal-nerve-and-muscles

Spasms of muscles along the route of these nerves can cause nerve entrapment and result in loss of muscle function or pain along the route of the nerves. As muscle attaches to bones and joints, spasms can cause misalignments of these structures and this can further complicate the problem.

Sometimes the muscle spasms are complicating for a muscle that is inhibited somewhere along the lateral or posterior kinetic chain such as the gluteus maximus, gluteus medius, the hamstrings and the rectus femoris or the psoas which overwork in order to to lift the leg to clear the dropped foot during walking. Neurokinetic therapy works well answering this question and correcting the problem.

As a applied kinesiologist and neurokinetic therapist I will either place my finger or hand on specific areas and then retests the muscle to see if the weakness is corrected. This is called therapy localization.

If the therapy localization is positive and the area involved is a joint or a muscle, I can move the area in a way to stimulate neuro/mechano receptors in the joint or muscle. This is called a “challenge’ and shows the direction of manipulation needed to improve function of the joint or muscle.

As a chiropractor, I would not only adjust the involved joints but check to see if the change in gait muscles has affected the spine and adjust affected level.

Stretches are given to the previously complicating muscles and exercises given to the previously inhibited muscles in order to break the pattern that caused the problem.

For  more information, please read:

The Use of Applied Kinesiology in a Chiropractic Examination

How a Combination of Applied Kinesiology, NeuroKinetic Therapy and Chiropractic Works

 

 

© 2016-Dr. Vittoria Repetto

Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic/ NKT practice at 230 W 13th St., NYC 10011; please go to www.drvittoriarepetto.com

And please check out the Patient Testimonials page on my web site.

 Want to be in the know on holistic information and postings? 

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How Really Small Muscles Can Be A Real Pain In The Neck – A NYC Chiropractor/Applied Kinesiologist/NKT Practitioner Explains

When a patient complains of neck pain or headaches, I first muscle test both the cervical flexor and extension muscles and muscles which when they test bilaterally weak such as the psoas or gluteus maximus suggest a fixation of the cervical vertebrae.

I ask questions: are the muscles weak and therefore affecting the alignment, movement of the cervical vertebrae?

Are one set of muscles weak or inhibited because of compensating (facilitating) muscle.

Or is the opposite true? Is it the hypertonic or facilitated muscle the problem?

Sometimes it’s not the bigger cervical flexor/extensor muscles that are causing pain either directly or by pulling vertebrae out of alignment and putting pressure on the nerves supplying the cervical area.

Sometimes it’s the half inch to inch muscles just below the occipital (base of your skull) that attach it to either the atlas (C1) or the axis (C2) or attach atlas to axis.

These muscles are called the Rectus Capitis Posterior Major, Rectus Capitis Minor, Obliquus Capitis Superior and Obliquus Capitis Inferior.

suboccipitaltriangle

The Rectus Capitis Posterior Major extends, laterally flexs and rotates the head.  The Rectus Capitis Minor extends and laterally flexes the head. The Obliquus Capitis Superior extends and laterally rotates the head. The Obliquus Capitis Inferior  rotates C1 and cranium.

Problems with these muscles can pull vertebrae out of alignment and put pressure on the cervical spinal roots and cause neck stiffness, pain and headaches. See dermatome map below for areas of innervation.

head dermatome

Note there is no C1 dermatome. The C1 root innervates the meninges of the posterior fossa of the skull and has no cutaneous branch; the posterior fossa also contains the meningeal branches of vagus and hypoglossal nerve. Neck stiffness may be a test of the C1 root that innervates the meninges.

For more information, please see the following blogs:

https://drvittoriarepetto.wordpress.com/2014/08/09/the-use-of-applied-kinesiology-in-a-chiropractic-examination/.

https://drvittoriarepetto.wordpress.com/2010/12/13/spinal-pain-not-being-helped-see-an-applied-kinesiologist-it-may-be-a-fixation/

https://drvittoriarepetto.wordpress.com/2016/06/23/how-a-combination-of-applied-kinesiology-neurokinetic-therapy-and-chiropractic-works/

For discussion about meninges:  https://drvittoriarepetto.wordpress.com/2016/05/28/why-is-my-neck-problem-causing-low-back-or-leg-pain-a-nyc-chiropractor-applied-kinesiologist-nkt-practitioner-explains-the-lovett-brother-effect-on-the-spine/

https://drvittoriarepetto.wordpress.com/2010/05/17/cranial-sacral-therapy-in-applied-kinesiology/

© 2016-Dr. Vittoria Repetto

Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic/ NKT practice at 230 W 13th St., NYC 10011; please go to www.drvittoriarepetto.com

And please check out the Patient Testimonials page on my web site.

 Want to be in the know on holistic information and postings? 

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How a Combination of Applied Kinesiology, NeuroKinetic Therapy and Chiropractic Works

A patient comes in with a problem, maybe low back pain. Most chiropractors would figure out what vertebrae /spinal nerve is involved and then adjust the segments involved.

However what is missed is why did the problem happen and how can it be fixed so that it does not happen again.

First we need to look at the muscles innervated by the spinal segment

As a Applied Kinesiologist, I test for the function of individual muscles. For example, we may find the latissimus dorsi muscle weak; that is a muscle that internally rotates, extends and adducts the arm/ shoulder. It also attracts into the lumbar and sacral vertebra and part of the pelvic crest. The weakness may seen either as a higher shoulder on the weak side or a rotation of the lumbar vertebrae. The questions to be asked are: why is the muscle weak? Is the muscle on the other side hypertonic or “too stronger.”

Is there a problem with the vascular or lymphatic drainage of that muscle? Is there a problem with the cranial-sacral system?

Is there a Lovett Brother association where a twisting of the spinal meninges affects an upper vertebrae as well as a low back spinal segment.

As a NKT practitioner, I ask “Is there a dysfunction in the coordination of muscles working in patterns?”

Is the above mentioned latissimus dorsi inhibited by the muscles that attach to the shoulder like the upper or middle trapezius or the levator scapulae or is it compensating (facilitating) for weak or inhibited muscles like the gluteus maximus or the quadratus lumborum or core muscles, for example.

back muscles

Is the patient using their neck muscles in the movement of their low back?

NeuroKinetic Therapy works with the concept that movement is performed in systems or patterns. The human brain has an affinity toward habits.

NKT identifies muscle imbalances by using muscle testing to determine what muscles are inhibited and what muscles are compensating (facilitating)for them.

I would test the muscles involved in the problematic movement. After an inhibited/weak muscle is found, I would muscle test a synergistic (a helper muscle) or an antagonist muscle (an opposing muscle} which is strong/facilitated that may be affecting the inhibited muscle.

That facilitated muscle would be therapy localized (the muscle is either touched or put in motion) and the inhibited muscle retested. If the TL strengthens the inhibited muscle, then I know that the TLed muscle is affecting the inhibited muscle.

And I can use AK techniques to release the TLed muscle. The inhibited muscle is then retested which should test strong now, the retesting causes a “neural lock” which reprograms the motor control center in the brain.

After balance is restored to the muscles, the vertebrae  ( or extremity joint) are adjusted.

Stretches are given to the previously facilitated muscles and exercises given to the previously inhibited muscles in order to break the pattern that caused the problem.

For more detailed information, please click on the following blogs:

https://drvittoriarepetto.wordpress.com/2014/08/09/the-use-of-applied-kinesiology-in-a-chiropractic-examination/.

http://neurokinetictherapy.com/what-is-neurokinetic-therapy

https://drvittoriarepetto.wordpress.com/2010/06/21/muscle-balancing-in-applied-kinesiology/

https://drvittoriarepetto.wordpress.com/2010/05/06/the-art-and-science-of-muscle-testing-in-applied-kinesiology/

https://drvittoriarepetto.wordpress.com/2015/09/20/a-nyc-chiropractorapplied-kinesiologist-starts-adding-neuro-kinetic-therapy-to-the-mix/

https://drvittoriarepetto.wordpress.com/2016/05/28/why-is-my-neck-problem-causing-low-back-or-leg-pain-a-nyc-chiropractor-applied-kinesiologist-nkt-practitioner-explains-the-lovett-brother-effect-on-the-spine/

https://drvittoriarepetto.wordpress.com/2014/01/01/a-nyc-chiropractorapplied-kinesiologist-talks-about-chiropractic-adjustments/

https://drvittoriarepetto.wordpress.com/2010/05/17/cranial-sacral-therapy-in-applied-kinesiology/

 

© 2016-Dr. Vittoria Repetto

Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic/ NKT practice at 230 W 13th St., NYC 10011; please go to www.drvittoriarepetto.com

And please check out the Patient Testimonials page on my web site.

 Want to be in the know on holistic information and postings? 

https://www.facebook.com/wvillagechiropracticappliedkinesiologynkt/

Or join me at Twitter: www.twitter.com/DrVRepetto

 

Looking At Posture As A Clue To Helping Patients – A NYC Chiropractor/Applied Kinesiologist/NKT Practitioner Explains

Two weeks ago, a relatively new patient who has been to other chiropractors paid me a compliment by saying that I was “unlike other chiropractors, I think about what is happening and what I need to do.”

One of the things I look at is posture. How does the patient present as they stand in front of me?

The other question that is relative to their posture is: How did they get that posture? Was there an accident where they were, for example, thrown forward and had to catch themselves when their bus suddenly stopped. What position was their body in? Hands forward? Head turned?

Postural findings may be due to muscular inhibition either as individual muscles or as a group of muscles that work together to do a certain movement

Or they may be due a compensating muscle inhibiting a muscle

Are the involved muscles hypotonic or hypertonic?

Or has a problem with their foot, for example, caused muscles to get inhibited or to compensate up the length of their body causing further joint and spinal pain?

bad-posture-posturepro

Here are some examples of muscles that may be involved in postural findings:

  • High Occiput – upper trapezius, neck flexor/extensor, gluteus medius, SCM, rectus capitus
  • Head rotation – latissimus, gluteus medius, lower trapezius
  • High Shoulder – opposite upper trapezius, quadratus lumborum
  • Low Shoulder – quadratus lumborum, latissimus
  • Elevated Ribs – rectus abdominal, oblique abdominals, quadratus lumborum
  • Lumbar deviation – psoas, lumbar erectors, multifidus, gluteus medius/maximus, tfl
  • High pelvis – sartorious, quadratus lumborum, hamstrings
  • Genu Valgus (Knock Knee) – TFL, gluteus max, adductors
  • Genu Varus (Bowed Knee) –adductor, popliteus, hamstrings

I use manual muscle testing to see if the muscles are hypotonic or hypertonic or inhibited by a compensating muscle.

I also look to see if there is a problem with the alignment of the joint the muscles cross or the vertebrae involved in the spinal innervation of the involved muscles.

For more detailed information, please check out the following blogs:

https://drvittoriarepetto.wordpress.com/2014/08/09/the-use-of-applied-kinesiology-in-a-chiropractic-examination/.

https://drvittoriarepetto.wordpress.com/2010/06/21/muscle-balancing-in-applied-kinesiology/

https://drvittoriarepetto.wordpress.com/2016/03/22/a-nyc-chiropractorapplied-kinesiologist-adds-neurokinetic-therapist-to-her-skill-list/

 

 

© 2016-Dr. Vittoria Repetto

Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic/ NKT practice at 230 W 13th St., NYC 10011; please go to www.drvittoriarepetto.com

And please check out the Patient Testimonials page on my web site.

 Want to be in the know on holistic information and postings? 

https://www.facebook.com/wvillagechiropracticappliedkinesiologynkt/

Or join me at Twitter: www.twitter.com/DrVRepetto

 

The Importance of Failing a Muscle Test – A NYC Chiropractor/Applied Kinesiologist/NeuroKinetic Therapist Explains

Yes I know that you are scratching your head over this one.

Don’t we want to have all our muscles testing strong?

Yes I answer but if you are in my office for treatment of a complaint, you may have muscles that are inhibited or weak or muscles that are compensating for the ones that are weak or inhibited. And these involved muscles most likely are part of the complaint that you are coming in for me to correct.

And if you are in for a maintenance/prevention visit, muscle testing can uncover a minor inhibition or compensation before it becomes a problem.

In my practice, I use both Applied Kinesiology and Neuro Kinetic Therapy.

With Applied Kinesiology, I test for the function of individual muscles. For example, we may find the latissimus dorsi muscle weak that is a muscle that internally rotates, extends and adducts the arm/ shoulder. It also attracts into the lumbar and sacral vertebra and part of the pelvic crest. The weakness may seen either as a higher shoulder on the weak side or a rotation of the lumbar vertebrae. The questions to be asked are: why is the muscle weak? Is the muscle on the other side hypertonic or “too stronger.”

testing rectus femoris

Neuro Kinetic Therapy works with the theory that movement is performed in systems or patterns instead of individual muscles. The human brain also has an affinity toward habits. Repetitive behaviors become patterns and these patterns require reprogramming when they become problematic. NKT identifies muscle imbalances by using muscle testing to determine what muscles are inhibited and what muscles are compensating for them.

After an inhibited/weak muscle is found, I would muscle test a synergistic (a helper muscle) or an antagonist muscle (an opposing muscle which is strong/facilitated that may be affecting the inhibited muscle. That facilitated muscle would be therapy localized (the muscle is either touched or put in motion) and the inhibited muscle retested. If the TL strengthens the inhibited muscle, then I know that the TLed muscle is affecting the inhibited muscle. And I use AK techniques to release the TLed muscle. The inhibited muscle is then retested which should test strong now, the retesting causes a “neural lock” which reprograms the motor control center in the brain.

For more detailed information, please click on the following blogs:

https://drvittoriarepetto.wordpress.com/2010/06/21/muscle-balancing-in-applied-kinesiology/

https://drvittoriarepetto.wordpress.com/2010/05/06/the-art-and-science-of-muscle-testing-in-applied-kinesiology/

https://drvittoriarepetto.wordpress.com/2014/08/09/the-use-of-applied-kinesiology-in-a-chiropractic-examination/.

https://drvittoriarepetto.wordpress.com/2015/09/20/a-nyc-chiropractorapplied-kinesiologist-starts-adding-neuro-kinetic-therapy-to-the-mix/

 

© 2016-Dr. Vittoria Repetto

 

 Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic/ NKT practice at 230 W 13th St., NYC 10011; please go to www.drvittoriarepetto.com

And please check out the Patient Testimonials page on my web site.

 Want to be in the know on holistic information and postings? 

https://www.facebook.com/wvillagechiropracticappliedkinesiologynkt/

Or join me at Twitter: www.twitter.com/DrVRepetto

 

Dr Vittoria Repetto’s New Web Site

 

Dr. Vittoria Repetto – NYC Chiropractor & Applied Kinesiologist

And please check out the Patient Testimonials at my web site.

 Want to be in the know on holistic information and postings? Follow me athttps://www.facebook.com/londonterracechiropracticandappliedkinesiology

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Tingling/Numbness/Weakness in Hand/Arm But Not Carpal Tunnel or Yr Neck; A NYC Chiropractor/Applied Kinesiologist/NeuroKinetic Therapist Explains

Do you have tingling or numbness in your hand that goes beyond your first three fingers?  Do you have weakness in your forearm, arm or shoulder despite your weight training routine?

It’s not carpal tunnel since it involves more than the fist three fingers. And you have no history of neck problems, all orthopedic tests and X-rays/MRI of the neck are negative.

You might have an entrapment syndrome of the brachial plexus nerves or subclavian artery/vein to the before mentioned structures.

This entrapment syndrome called Thoracic Outlet Syndrome is caused by three major conditions; Anterior Scalene Syndrome, Costoclavicular Syndrome and Pectoralis Minor Syndrome as well as some minor causes.

TOS

In the first condition called Anterior Scalene Syndrome, the brachial plexus nerves arising from C5, C6, C7, C8 & T1 nerve roots is trapped between the anterior and middle scalene muscles which may be in spasm or compensating for inhibited neck muscles.

This can be assessed by palpating for a decrease in strength of the radial pulse at the wrist. The patient is asked to ipsilaterally rotate, contralaterally laterally flex, and extend his neck at the spinal joints, while the radial pulse is palpated; this called Adson’s Test. Decrease in strength of the radial pulse is positive for the syndrome.

Treatment consists of using spindle work on the bellies of the scalene muscles or golgi tendons of the scalene attachments and of balancing the other neck muscles which can be either inhibited or compensating.

In the second condition Costoclavicular Syndrome, the brachial plexus and subclavian artery and vein run between the first rib and clavicle in the medial pectoral region. If the posture of the relationship of the clavicle and first rib changes and they approximate each other as often happens with rounded and slumped shoulders and impingement may occur.

This can be assessed by palpating for a decrease in strength of the radial pulse at the wrist when the patient is asked to stick his chest out and pull the shoulder girdle back and down similar to the military posture of attention. Again, weakening of the strength of the radial pulse would be considered to be a positive sign. This is called Eden’s test.

Treatment consists of checking muscles such as the SCM and the subclavius that attach to the area, improving the patient’s posture and checking muscles that resist this bad postural pattern such as the rhomboids and the middle trapezius.

In the third condition Pectoralis Minor Syndrome, a tight pectoralis minor muscle compresses the brachial plexus and/or subclavian vessels against the rib cage. The assessment is to bring the patient’s arm up and back. This position called Wright’s Test stretches and pulls the pectoralis minor taut against the rib cage

Treatment consists of checking for either an inhibited or facilitated pectoralis minor, or other muscles that can be inhibiting or compensating such as the serratus anterior, latissimus dorsi or the lower trapezius.

Other minor conditions such as  when both the medial and ulnar nerve getting entrapped by a spastic muscle such as the pronator or by a misalignment of the radius and ulna bone can happen and need to be ruled out.

forearm muscles

For additional information, please check out:  https://drvittoriarepetto.wordpress.com/2015/09/20/a-nyc-chiropractorapplied-kinesiologist-starts-adding-neuro-kinetic-therapy-to-the-mix/

https://drvittoriarepetto.wordpress.com/2010/06/21/muscle-balancing-in-applied-kinesiology/

https://drvittoriarepetto.wordpress.com/2012/05/23/how-a-nyc-chiropractorapplied-kinesiologist-treats-carpal-tunnel-syndrome/

 

© 2015-Dr. Vittoria Repetto

© Revised 2016 – Dr Vittoria Repetto

Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic/ NKT practice at 230 W 13th St., NYC 10011; please go to www.drvittoriarepetto.com

And please check out the Patient Testimonials page on my web site.

 Want to be in the know on holistic information and postings? 

https://www.facebook.com/wvillagechiropracticappliedkinesiologynkt/

Or join me at Twitter: www.twitter.com/DrVRepetto