Common Patterns of Lower Extremity Subluxations

Figure 1. Stress test for external rotation of the proximal tibia.

Figure 1. Stress test for external rotation of the proximal tibia.

By: Jeffrey D. Olsen, DC

Activator Methods Chiropractic Technique (AMCT) suggests that, before proceeding to the pelvis or any portion of the axial skeleton, doctors must first clear the subluxations and remove any instability from the lower extremity.1 The Activator Adjusting Instrument, with the proper line of drive, is your tool for removing subluxations. Furthermore, Foot Levelers’ custom-made orthotics provide the stability necessary for holding the corrections.

After several visits involving a Basic scan of the lower extremities, the doctor will often note patterns of consistently repeating misalignments. This may even be true in the absence of such obvious conditions as trauma, excessive weight, or ligament laxity, where the pedal foundation has obviously been disrupted. Because of the body’s closed Kinetic Chain arrangement, misalignment at one segment is often associated with compensatory changes elsewhere. Therefore, the Activator protocol provides for a thorough evaluation of many links in the Kinetic Chain.

Figure 2. Stress test for lateral patella

Figure 2. Stress test for lateral patella

The most common structural misalignment of the lower extremity is excessive pronation, affecting the medial arch primarily. In fact, there are three natural arches of the foot, which help form the plantar vault system. The strength and function of this postural foundation depend on the proper alignment of bones and the support of the ligamentous tissues. Whenever there is compromise of the arch structures or the supporting soft tissues, the postural foundation is adversely affected.

When you have to repeatedly adjust the talus and cuboid, with their respective knee subluxations, look for the following common pattern, using Advanced procedures. The hyperpronated foot will lead to an excessively externally rotated tibia with visual foot flaring. The tibial rotation affects patellar tracking, with a common finding of lateral patella. You will be interested to find the correlation between stress testing the affected areas of the lower extremity and your patients’ subjective knee and hip complaints.

Stress Tests

To stress test for an externally rotated tibia, grab the posterior proximal tibia with one hand (over the belly of the gastrocnemius), while stabilizing the posterior distal femur with the opposite hand. Externally rotate the tibia to accentuate the misalignment and check position 1 for shortening of the PD leg (Fig. 1). If so, adjust the tibia.

Figure 3. Adjustment for external rotation of the proximal tibia—LOD is lateral to medial.

Figure 3. Adjustment for external rotation of the proximal tibia—LOD is lateral to medial.

To stress test for a lateral patella subluxation, reach anterior to the tibia and gently press the patella in a lateral direction, within the trochlear groove (Fig. 2). Look for shortening of the PD leg in position 1. Adjust as indicated.


To adjust an externally rotated tibia, contact the lateral margin of the anterior tibial tubercle with a lateral to medial line of drive (Fig. 3). Sliding the fingers of your stabilizing hand between the patient’s tibia and the table will allow you to lift the leg and support the tip of the adjusting instrument on the proper contact site.

Adjust a lateral patella by contacting the lateral border of the patella (Fig. 4). The line of drive is straight medial, across the trochlear groove (opposite the direction of subluxation). NOTE: The same tibial rotation, which can affect patellar tracking, can also be responsible for external rotation of the femur and related hip-pain syndromes.


With AMCT, you can restore proper joint alignment and nerve communication, and even remove postural distortions, while patients are on the treatment table. However, when patients stand back up and reintroduce the forces of gravity, everything changes. Although joint alignment and integrity can be corrected with specific Activator adjustments, if the underlying stress is not removed from the feet, the misalignments will return.

Figure 4. Adjustment for lateral patella—LOD is medial.

Figure 4. Adjustment for lateral patella—LOD is medial.

Whatever the cause, ligaments stretched beyond their ability to support the arches of the feet will not maintain your adjustments. It is well documented that once stretched, not even surgical reduction will restore a ligament to its original condition. This can be frustrating for the doctor and patient when repeated adjustments seem ineffective.

Orthotic Support

If you practice like most Activator doctors, you know that Foot Levelers’ custom-made orthotics are indicated when the initial examination reveals any of the “5 Red Flags” of excessive pronation (Fig. 5), or when you have to repeatedly adjust the same lower extremity subluxation(s).

A Foot Levelers orthotic, Sandalthotic®, or Shoethotic® with the patent-pending Gait Cycle System™ is a perfect match with AMCT or any other technique, which looks to remove biomechanical stress from the postural foundation. Specifically, every custom-made orthotic supports the three arches of the foot. Therefore, once the lower extremity is adjusted and stabilized with an orthotic, the extent of ligament laxity becomes irrelevant as far as its effect on the closed Kinetic Chain.


  1. Fuhr AW et al. Activator Methods Chiropractic Technique. St. Louis: Mosby-Year Book, Inc., 1997:119.

About the Author

Dr. Jeffrey D. Olsen is a 1996 Presidential Scholar and summa cum laude graduate of Palmer College of Chiropractic. He has been in private practice, with his two brothers/partners since 1997, in Roanoke, VA. In addition to his practice, Dr. Olsen has instructed as an adjunct faculty member at the College of Health Sciences in Roanoke, teaching Anatomy and Physiology in the Physician Assistant department. He is currently serving as Technical Advisor at Foot Levelers, Inc. In 2000, Dr. Olsen achieved “Advanced Proficiency, Activator Methods.”