Non-Subluxate Versus Asymptomatic

By: Mark N. Charrette, DC

Figure 1. Conditions associated with excessive pronation.

Figure 1. Conditions associated with excessive pronation.

How often has the Chiropractor heard from his or her patient that the area being adjusted “doesn’t hurt”? On the other hand, how often has a patient told us that an area doesn’t hurt, or feels good—so we as Chiropractors decide not to examine it?

Painless Problems

There is a huge difference between non-subluxated and asymptomatic joints. I think most people would agree, and it is my definite opinion that many subluxations occur in the absence of any detectable pain. These subluxations can cause many things, including neurological deficits, biomechanical lesions and compensations, and a multitude of symptomatology not necessarily involving pain.

A good example of this is the typical adult with pronated feet. It is interesting to note that most excessive foot pronation does not cause noticeable foot symptomatology. The most common adult pattern is one that involves bilateral but asymmetrical excessive foot pronation, internal tibial and femoral rotation, with some degree of pelvic tilting and anterior translation.

Neurologically, this condition can cause proprioceptive changes and muscular imbalances. This is why the Chiropractor may notice a patient’s shoe with excessive posterior/lateral heel wear, and a foot that is basically longer, wider, and flatter and may exhibit:

  • Foot flare/toe out
  • Achilles tendon bowing
  • Patellar rotation
  • Visible decrease of the medial longitudinal arch (Fig. 1)
Figure 2. Greater trochanter “show and feel” demonstration.

Figure 2. Greater trochanter “show and feel” demonstration.

“Show and Feel”

A good way to demonstrate to the patient that his/her feet may be involved in knee, hip, or low back symptomatology is by using what I refer to as a “show and feel” demonstration:

Have the patient stand with the feet shoulder-width apart. Place the four finger pads of each hand along the bony prominences of the greater trochanter (Fig. 2). Next, have the patient roll the feet inwards (excessive pronation) and then outwards (excessive supination). Do this several times. The patient will notice that the hip joints move more than he/she would think. The second part of this demonstration is to have the patient touch only one trochanter with his/her finger pads. This time have the patient roll the foot inward and outward only slightly. The patient is usually surprised how much the hip socket moves. This shows that even slight motion of the foot can cause the knee and hip to move and potentially cause symptoms. This demonstration is an easy initial way to suggest to the patient that stabilization of the feet will help overall structural well-being.

Orthotic Support

Figure 3. InMotion orthotics provide superior support for the body

Figure 3. InMotion orthotics provide superior support for the body

Stabilization of excessive pronation can be achieved by utilizing Foot Levelers’ custom-made, flexible orthotics. These devices support all three arches of the foot within their normal ranges and allow for flexible locomotion. In-shoe orthotics have been called “the only method of controlling overpronation at the subtalar joint.”1 More recently, research published in the Journal of Manipulative and Physiological Therapeutics (JMPT), proves that Foot Levelers’ custom-made, flexible orthotics improve the structural alignment of the foot, thereby creating a more symmetrical foundation throughout the Kinetic Chain.2

Gait Cycle System™

Some of Foot Levelers’ functional orthotics are built with the Gait Cycle System™, which provides advanced support with material adapted for each phase of the gait cycle (Fig. 4). Zorbacel® heel pads dissipate 90% of the shock energy produced at heel strike. Heel strike to midstance is maintained with the StanceGuard™ System for variable firmness and flexibility, and supports in all three functional arches. The intent is to control the angle and timing of pronation, not to restrict or eliminate normal foot motion.3 Energy expenditure required for propulsion is minimized using Propacel™—an enhanced propulsion system for the forefoot.

Conclusion

Figure 4. Foot Levelers’ Gait Cycle System

Figure 4. Foot Levelers’ Gait Cycle System

My very strong recommendation is for the Chiropractor not to confuse an asymptomatic joint with a non-subluxated joint. They are very different. The subluxated but asymptomatic joints must be examined, adjusted, stabilized, and rehabilitated appropriately. Stabilization is best achieved with Foot Levelers’ custom orthotics.

References

  1. Baycroft CM, Culp V. Running shoes: design facts and functional fantasies. Chiro Sports Med 1993; 7(1):6-8.
  2. Kuhn DR, Shibley NJ, Austin WM, Yochum TR. Radiographic evaluation of weightbearing orthotics and their effect on flexible pes planus. JMPT 1999; 22(4):221-226.
  3. Christensen KD. Orthotics: do they really help a Chiropractic patient? ACA J Chiro 1991; 27(4):63-71.

About the Author

Dr. Mark N. Charrette is a 1980 summa cum laude graduate of Palmer College of Chiropractic in Davenport, IA and a former NCAA All-American swimmer. He has taught hundreds of seminars in the United States and internationally on Chiropractic adjustive procedures and biomechanics.