plantar fasciitis: a unique treatment
DESCRIPTION
Dr. Perry Nickelston, DC, FMS, SFMA presentation for the Association of NJ Chiropractors on Plantar Fasciitis. Using movement and laser therapy as treatment.TRANSCRIPT
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‘Step Outside the Foot’
Perry Nickelston, DC, FMS, SFMAPain Laser Center, LLC
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Case Study
Plantar Fasciitis ?
Assessment/Evaluations
Treatment Protocols
Grassroots branding
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35 year old female runnerPain on bottom of right foot and heel8-months
*Podiatrist (orthotics)*Physical Therapy (US, stim, exercise)*Chiropractic*Cortisone injections (2)
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Insanity- ‘Doing the same thing over and over expecting a different result.’
MOVEMENT DYSFUNCTION Joint by joint kinematic chain Mobility, stability, muscle activation
Site vs. Source Treat both parametersLaser…functional movement…
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“The physician arrives at a diagnosis not from the evidence furnished by one painful movement but by careful determination of a consistent pattern.”
-Dr. James Cyriax
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Multi-Segmental Flexion Multi-Segmental Extension Multi-Segmental Rotation Single Leg Stance Squatting Pattern Upper Extremity Movement Patterns Cervical Movement Patterns
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Each assessment of the SFMA must be scored with one of four possible answers:
1. Functional and Non-Painful (FN)
2. Functional and Painful (FP)
3. Dysfunctional and Painful (DP)
4. Dysfunctional and Non-Painful (DN)**
SCORING SYSTEM
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*Dysfunctional does not always mean limited movement…..can also be an abnormal pattern, timing, or increased exertion.
KEY POINT
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Don’t Chase PAIN
Traditional model attacks the inflamed tissue.
We want to find and treat the source of the pain using a systematic
examination.
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Decreased ankle dorsi-flexion (B) R>L Decreased hip extension (R) Decreased hip internal rotation (B) Decreased T-Spine rotation (L) Decreased Cervical Spine Flexion/ (L)
rotation Decreased hip stability (L)
Spinal Fixations:Occiput…T12/L1…Sacral Apex
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Trigger points Soleus, gastroc, tibialis
posterior/anterior, vastus medialis/lateralis, adductor longus/magnus, psoas,)
Hip Cuff (Medius/minimus,
piriformis, TFL, ITB, QL)
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•Plantar•Sacrotuberous•Glutei Maximi Slip•Thoracolumbar•Suboccipital
*Lateral Line*Deep Frontal Line*Spiral Line
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• Diagnosis
• Dosages per square area•Joules
• Application process
•Frequency of therapy
Photo-biostimulation
Cellular regeneration
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1,000 J Thoracolumbar Fascia500J Suboccipital 500J L5/S11,000J (B) Hip1,500J Gastroc/Soleus1,500 J Plantar Surface
Settings: 10W CW 10 Min session 6 treatments 2x week / 3 Weeks
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(MFR, Tp, ART)
Foam Rollers
Laser Therapy
Active Isolated Stretching
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Mulligan (B) hips
Mulligan (B) ankles
Ankle mobility drills
Diversified Spinal
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Glute activation DrillsMini-bands
Hip Extension Drills
MUSCLE ACTIVATION
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Diaphragmatic Breathing
Diaphragm Release
Laser Therapy Diaphragm
T-Spine Rotation
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How do you assess movement?
1. Squatting2. Stepping3. Lunging4. Reaching5. Leg raising6. Push-up7. Rotational stability
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Eight laser treatments Class 4 Laser Ten sessions of soft tissue Six sessions of activation/stabilization Two sessions of breathing instruction
Released from care asymptomatic withinstructions on use of foam
roller/stretching.
Maintenance program every FOUR weeks.
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Class 4 Laser Therapy
Movement Assessment
Mobility/Stability
Soft Tissue
Stop Chasing Pain
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Why did she seek me out for care? RESULTS LASER UNIQUENESS
Workshop/Seminar evaluations for her running club. Runners know runners Plantar fasciitis knows…
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