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.

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Rib Pain or Intercostal Neuritis – A NYC Chiropractor/Applied Kinesiologist/NKT Practitioner Explains

Every few times during the year, I get a patient with a displaced rib head. (I’ve had one or two myself)  The sensation is an intense stabbing pain that “takes your breath away” in either the back or the front of the chest; sometimes the pain goes round the rib and sometimes seems to go from the back to the front like a knife.

When a patient comes in, we evaluate them via examination and a detailed history to rule out things like shingles or referred pain for heart, lung and gastrointestinal problems. A lot of the times, the patient has already been evaluated by their M.D. for these conditions with negative results.

But it’s usually a rib head displactment either at the anterior attachment at the sterum [breastbone] or at the posterior attachment at the transverse process of a thoracic vertebrae. The intercostal nerve runs from the anterior rami of the thoracic spinal nerves from T1 to T11 and runs [along with the artery and vein] between the intercostal muscles to the breastbone.

intercostal-nerve

intercostal-muscle

Of course it’s not surprising that a rib displacement “takes yr breath away” as the ribs (& the clavicle) and a lot of the muscles attached to them are involved in inspiration and expiration. Some of these muscles are the diaphragm, the external & internal intercostals, the serratus anticus, pectoralia minor, scalene & SCM muscles.

breathing-muscles

Muscles attached to the ribs or thoracic spine which may not be directly involved in breathing but may be compensating for a problem with the breathing muscles. Some of these muscles are the rectus abdominis, the abdominal oblique muscles, the psoas, the quadratus lumborum, the rhomboids and latissimus dorsi; they may be on the same or contralateral side to the displaced rib.

Before I adjust any displacement of the ribs involved or the breastbone or the clavicle as a doctor of chiropractic; I need to balance the muscle pull on the affected area.

I use the muscle testing used in both Applied Kinesiology and NeuroKinetic therapy.

As a Applied Kinesiologist, I test for the function of individual muscles. The questions to be asked are: why is the muscle weak? Is the muscle on the other side hypertonic or “too stronger.” Is the weakness due to a spinal/nerve problem, a vascular problem, a problem with lymphatic function, a nutritional default, a problem with organ function or an acupoint associated w/ that muscle?

The Use of Applied Kinesiology in a Chiropractic Examination

As a NKT practitioner, I ask “Is there a dysfunction in the coordination of muscles working in patterns?” NeuroKinetic Therapy works with that concept that movement is performed in systems or patterns. NKT identifies muscle imbalances by using muscle testing to determine what muscles are inhibited and what muscles are compensating (facilitating) for them.

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

Once the above muscle related questions are answered, I can adjust the involved rib, clavicle or spinal segment.

Stretches are given to the previously facilitated (or hypertonic) muscles and exercises given to the previously inhibited (or weak/hypotonic) muscles in order to break the pattern that caused the problem.

For a blog on the effects of the breathing muscles on asthma, please check out: The Musculoskeletal Aspects of Asthma

© 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.

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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.

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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.

It is not unusual to have a patient come in my office with neck pain also complaining of low back or leg pain that starts with or soon after the onset of the neck pain. Or vice versa: neck pain or headaches or jaw problems after the onset of low back pain.

A lot of doctors don’t think that there is a relationship. But since they came on around the same time they probably are related. The major thing that could connect them is the meninges; three membranes covering the brain, spinal cord and housing the cerebrospinal fluid. If injured it could affect nerves throughout the spine.

spinal-anatomy-e1409590019734

A good illustration of how an injury can affect different levels is to hold the upper part of an elastic band with your hand and then hold the bottom of the band with your other hand. Then twist your upper part of the band; note how the bottom of the elastic band also twists. Now imagine how the meninges surrounding a spinal nerve as it comes off the spinal cord can affect the structures innervated by that spinal nerve.

This explains why if there is a rotation in Cervical 1 there will always be a rotation in Lumbar 5, its ‘Lovett Partner’. With all the listings they can work both ways. For example, a dysfunction at L5 can cause a C1 dysfunction and a C1 dysfunction can cause an L5.

Here’s a helpful illustration: lovatt-brother-relationship

These relationships are looked at by Applied Kinesiologists and NKT Practitioner.

Another possible relationship is one of spinal fixations; please check out this blog for more information: https://drvittoriarepetto.wordpress.com/spinal-pain-not-being-helped-see-an-applied-kinesiologist-it-may-be-a-fixation/

For another article on the neck/low back connection; please check out: Neck Problems Causing Low Back Pain & Vice Versa – A NYC Chiropractor / Applied Kinesiologist / NKT Practitioner Explains

So if you are having unexplained pain in different areas, please consider being examined by someone familiar with the above principles.

 

 

© 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.

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Seminar I’m Taking: How to Thrive in a Toxic World through Nutrition & Lifestyle

This coming June 5th I’ll be attending a seminar on Whole Detox: How to Thrive in a Toxic World through Nutrition & Lifestyle.

The term “ detoxification ” is widely debated and discussed within the clinical community. In this presentation, the scope of detoxification practices and the spectrum of offerings and their validity will be highlighted. A deeper dive into the recent scientific developments in this pivotal area of medicine will be featured from the angles of both biochemistry and genetic expression, with particular focus on (1) modulation of metabolic biotransformation through phase I and phase II enzyme induction or inhibition; (2) alkalinization; and (3) heavy metal metabolism . Special emphasis will be given to nutrition, nutrient actives, and botanicals for their influence in these pathways. Furthermore, the incorporation of lifestyle changes will be included as part of the detoxification discussion for a more well-rounded, whole picture, whole-self approach.

liver-detox1

Objectives:

• To understand the context of detoxification practices as they relate to health and disease, and their general view and acceptance in the medical arena

• To identify biochemical and genetic pathways involved in detoxification processes: ARE gene upregulation biotransformative enzyme induction or inhibition, alkalinization, and heavy metal metabolism

• To understand the role of nutrition, nutrient actives, and botanicals in modulating detoxification processes

• To learn the importance of addressing lifestyle modalities as part of the detoxification process.

For an article on why fasting on juices do not make an effective liver detox: https://drvittoriarepetto.wordpress.com/2011/08/24/a-nyc-chiropractor-recommends-how-to-do-a-healthy-liver-detox/

Presenters are: Tricia Paulson, ND & Deanna Minich, PhD

Tricia Paulson, ND, is the founder of and primary physician at True Health Naturopathic Medicine. As an educator and speaker for the Wisconsin Chiropractic Association and Nutrition Dynamics, she has developed and implemented curricula in clinical nutrition, detoxification and gut restoration. FirstLine Therapy is the cornerstone of her functional medicine practice which specializes in the treatment of chronic lifestyle diseases through a patient-centered approach

Dr. Minich received her doctorate in Medical Sciences (Human Nutrition and Metabolism ) from the University of Groningen, The Netherlands, and her Master’s Degree in Human Nutrition and Metabolism from the University of Illinois at Chicago. She is a fellow of the American College of Nutrition, and a member of both the American College of Nutrition and the American Society for Nutrition Science. Dr. Minich has published over 15 articles in peer-reviewed, scientific journals, and has published three books on nutrition. At Metagenics, Dr. Minich has numerous responsibilities, including counseling patients using functional medicine protocols at the Functional Medicine Research Center®—the clinical research arm of Metagenics.

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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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

 

Holiday Wishes From Dr. Vittoria Repetto

Whether you celebrate Hanukkah, Winter Solstice, Christmas or Kwanzaa or just the New Year, I leave you with these wishes:

  • May peace break into your home
  • May thieves come to steal your debts!
  • May the pockets of your jeans become a magnet for $100 bills!
  • May love stick to your face like Vaseline
  • May laughter assault your lips!
  • May happiness slap you across the face
  • And may your tears be that of joy!
  • May the problems you had, forget your home address!

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Want more information on Dr. Vittoria Repetto and her NYC Applied Kinesiology/Chiropractic practice at 455 W 23rd St., NYC 10011; please go towww.drvittoriarepetto.com

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

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