In the 2004 film "National Treasure," Nicolas Cage stars as treasure hunter Benjamin Gates, who, with the help of his loyal friends and family, undercovers immense treasures and secrets from U.S. history. The movie opens with Gates and his friend Riley finding an old, wooden shipping vessel, the Charlotte, buried in snow and ice that has been frozen in time. A clue led them there and the clue was simply, "The secret lies with Charlotte."
Fast forward to the end of the movie and Gates is stranded below ground in old caverns, with no way out. He notices a small carving in the wall. He studies the carving and notices it resembles the carving of the meerschaum pipe found on the Charlotte.
He slowly reaches into his pocket, retrieves that old pipe and whispers these words: "The secret lies with Charlotte. Could it really be that simple?" He gently places the pipe into the wall, slowly turns the stone, and unlocks the greatest discovery of treasures known to man.
Biomechanics: Could Caring for Our Patients Also Be That Simple?
When considering the biomechanics of the body, perhaps we should ask the same question when considering how to approach caring for our patients. Could it really be that simple? Could we simply start with the foundation of the body and build from there? Should we start with the feet and look to see how they are doing mechanically, and then work from there?
When we are adjusting the spine and extremities, we are doing so to correct abnormal loading within the body. Correcting the abnormal load must begin with the feet. After all, if the foundation is not sound, the structures above will not be, either. Dr. Monte Greenawalt always said, "When the foot hits the ground, everything changes."
Enter "The Crooked Man." I have patients look at this on the wall in my office and before I can even start my exam they say, "That is me!" Patients can understand the simplicity of the crooked man/woman and can understand the basic premise before we even start to talk treatment.
Since beginning this approach of considering the feet first, I have found that patients have been able to unlock the treasures of health and life with less pain to a much greater extent. Patients get it!
Compensation Patterns From Head to Toe – The Kinetic Chain
Consider the biomechanics that the crooked man/woman demonstrates. Pronation of the foot causes a cascade of events to occur up the kinetic chain. The foot itself undergoes mechanical stresses with collapse of the three arches (medial longitudinal, lateral longitudinal, and anterior transverse). This can be a major contributing factor to plantar fasciitis. The collapsed arches leads to an altered Q angle of the knee, with increased biomechanical stresses on the knee.
Next up the kinetic chain is the hip and unleveling of the hips when comparing side to side. This causes increased anterior load on the hip and increased torquing within the pelvis. The spine compensates and adapts to all the biomechanical abnormalities upon which it sits.
I encourage doctors to perform a foot scan on every patient for two reasons: 1) A foot scan gives us particularly important pieces of information about the foot biomechanics; and 2) A scan creates visual evidence for the patient to see how their foot is affecting their body mechanics.
With so much technology available to us, we can use the technology to help patients see things they would overlook otherwise; and we as providers can correlate the findings from the foot scan with orthopedic, neurologic and radiographic findings.
A Profession, Not a Treatment
What forms of treatment do you provide at your office? The cornerstone of treatment we provide as chiropractors is spinal manipulation; but beyond that, what other treatments do chiropractors provide? Here is a list that is far from comprehensive, but covers what many providers can do: nutrition, modalities such as interferential and ultrasound, low-level laser light therapy, acupuncture, dry needling, instrument-assisted soft-tissue manipulation (IASTM), rehabilitative exercise, spinal decompression, kinesiotaping, and custom orthotics ... just to name a few.
Each of these is a tool in our toolbox that we can use to provide care for our patients. We don't use every tool with every patient, but a combination can be used to provide what the doctor feels will provide the maximum benefit.
Are Orthotics in Your Toolbox?
The approach I promote is based upon correcting abnormal loading and restoring balance. This incorporates custom orthotics to correct pronation and its domino-like effect up the kinetic chain. The orthotics also help to correct the pelvic unleveling caused by altered biomechanics in the feet.
Spinal manipulation is used to correct the vertebral subluxations that have occurred over time due to the abnormal loading. Then other treatment tools are used to address the soft-tissue compensations and adaptations that have developed over time. This may include rehab, IASTM, taping, modalities, dry needling, etc. This three-pronged approach of 1) spinal manipulation, 2) orthotics and 3) soft-tissue treatment has yielded better outcomes and better patient compliance.
Unlock the Secret to Improving Your Patient Care and Practice
Benjamin Gates was surprised at the simplicity of solving the clues once everything seemed to fall into place. After 30-plus years in practice, many certification classes and hundreds of hours of continuing education, I believe I have found that same simplicity in my practice.
Look at the feet and correct the imbalance there. Use spinal manipulation to unlock the years of subluxated joints. Treat the soft tissue with the tools you have in your treatment toolbox. Could it really be that simple? The secret lies with Charlotte!
Dr. Jeff McKinley graduated from Logan and completed post-doctorate training in sports injuries. He served a two-week rotation at the U.S. Olympic Training Center, and has been recognized as a fellow of the International College of Chiropractic, a certified posture exercise professional, and a certified kinesiotaping practitioner. He is also certified in the SFMA. He has served as president of the Tennessee Chiropractic Association, alternate state delegate to the ACA, and member of the Medicare Carrier Advisory Committee for Tennessee and the ACA.