Re: Re: Leg pain info- Suggestions- follow up...+ x-rays

[Guest guest]

OK, so I get the x-rays from 07 which were taken after the fall on her coccyx and enclosed them here.

As you can see, her pelvis is torqued with all sorts of distortions.

Rookie doctors will always ASSUME that the distortions are from her recent trauma and pain causing splinting spasms.

Old geezers will withhold judgment and ask if the distortion pre-existed the injury.

(“It is better to keep your mouth shut and appear stupid than to open it and remove all doubt.” ---Mark Twain)

This is a typical supine medical x-ray so we can’t see the ground impact of leg length disparity.

(Taken in Costa Rica but could we have a name marker and ovary shields please? This is the 21st century mi amigos!) Thanks for the date but what does “RB” mean?

Anyway, note that the pubic symphysis is asymmetrical.

....and what the heck are the two metallic pin or staple appearing opacities (patient doesn’t know; probably clothing). The opacity on the right is clearly an artifact.

Interestingly, I didn’t treat the actual painful calf but everything else around it (navicular adjustment, tape, pelvis adjustment).

Update: not to get too excited, but she is 3 days post adjustment and did the workout class this morning and is pain free!

She isn’t running so her exercise is milder.

The Elastikon tape is probably helping as it supports the arch while at rest.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: Abrahamson <drscott@...>

Date: Fri, 08 Apr 2011 13:14:38 -0700

Abrahamson <drscott@...>, " Dr. Todd Turnbull, DC " <drt@...>, < >

Subject: Re: Leg pain info- Suggestions- follow up...

This is the 23 year old athletic female with Tibialis posterior pain; BAD pain.

Yelling out loud pain. Don’t touch my leg pain!

While talking with her after class Dr. Devine happened to be listening in and recommended addressing her pelvis distortion. He then pointed at me and said “He will take care of you.” Classy guy.

She came in today for an exam and her calf was excruciatingly painful to light pressure. Her history revealed that she had fractured her tail bone while hiking in Central America 2-3 years ago, had to hike out 2 miles and ride six hours in a car to the help. Her host family included a medical doctor who took x-rays revealing a severely distorted pelvis and a fractured tailbone. The doctor said her tailbone and she recovered without therapy. I’ll share the x-ray when she brings it in.

Examination revealed a long-standing right posterior inferior ileum, tight hamstring muscles on the right. She also mentioned that she has had three bouts of severe sciatica which have responded slowly to acupuncture, ice, and time. She said that she was reticent to see a chiropractor because she was adjusted at 11 years old in Utah and the chiropractor dropped on her like a ton of bricks. (What’s up with that?)

Consulting with Dr. Domby who is a diplomate in applied kinesiology and a lifelong runner, he is convinced that strengthening the muscles will address arch distortion issues. He has cured tons of people addressing muscle strength and prescribing barefoot shoes.

When questioned further about the exact nature of her rehabilitation, the patient described a sort of leg sled device to perform an exercise called “blast offs” where she would thrust her legs and feet in an explosive manner to mimic the contraction necessary to support the arch in running.

I was wondering if the therapist’s attempt to mimic the sudden contractions necessary to support the arch aren’t actually the very exercises which continued to tear the muscles. Obviously, a sudden explosive contraction under strain is a recipe for straining already fragile muscles. Maybe the patient should have been exercising in a slow sustained manner until her muscles were strong enough to move up to the ballistic level. I was also thinking that she might be a good candidate for swimming with swim fins as it provides a brutal amount of exercise and is extremely safe.

I adjusted her pelvis which moved easily, [Of course, I’m an excellent adjuster. -Chiropractic Rain Man] adjusted her proximal tibia, her navicular, grabbed a handful of dorsal’s [ala Dick Stober] and of course adjusted her neck. I wrapped Elastikon tape (WAY stronger than Kinesiotape, but still stretchy) around her foot from the medial arch over the top, around the bottom, and up the medial posterior calf to mimic the extrinsic foot muscles. I backed it up with another length of tape, and anchored at the top. I instructed the patient to leave it on until Monday when I see her again.

I will keep you posted and if chiropractic helps her, we might make it into the best practices guidelines some day.

Your thoughts are always welcome.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: Abrahamson <drscott@...>

Date: Wed, 06 Apr 2011 08:34:16 -0700

" Dr. Todd Turnbull, DC " <drt@...>, < >

Subject: Re: Re: Leg pain info- Suggestions?

Well, I just met her at a workout class so I wasn’t able to muscle test.

I’m trying to get her in for a series of pelvis adjustments.

I heard somewhere that adjusting the pelvis can affect the foot.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: " Dr. Todd Turnbull, DC " <drt@...>

Date: Wed, 06 Apr 2011 06:23:37 -0000

< >

Subject: Re: Leg pain info- Suggestions?

,

What does muscle testing reveal?

Has she been tested for soleus, gastroc and flexor hallicus longus?Also inferior pubis and adductor issues can refer into the lower leg.

Dr. Todd Turnbull, DC

5223 NE Sandy Blvd

Portland, OR 97213

503-8053865

>

> I met a young gal at a boot camp class who had recently been tested for

> compartment syndrome. She clearly has tibialis posterior pain so I was

> wondering what the current conventional wisdom is regarding this.

>

> One theory holds that pronation causes the tibialis posterior muscle to

> attempt to raise the arch and frequently strains the muscle. Lifting the

> arches with orthotics cushions the collapse of the arch in mid step thus

> protecting the muscle.

>

> It appears in reading “Born to Run”, that shoes and orthotics are making

> runner's feet weaker thus ushering in the concept of barefoot running. This

> is supposed to allow the intrinsic and extrinsic foot muscles to regain

> strength so that we can run well into old age like our meat eating, grain

> avoiding, healthy as a pin, celiac-free ancestors! Of course, if the muscles

> are already strained there is going to have to be a rehab. period, but

> then, look out prey, here come de predator!

>

> Currently, as you can tell from the attached description, this gal is now

> experiencing pain from even mild activity. It's certainly interesting to see

> how the sports medicine world reveals itself by observing their progression

> of care.

>

> Suggestions?

>

> E. Abrahamson, D.C.

> Chiropractic physician

> Lake Oswego Chiropractic Clinic

> 315 Second Street

> Lake Oswego, OR 97034

> 503-635-6246

> Website: http://www.lakeoswegochiro.com

>

> ------ Forwarded Message

>

> >

> > Hi !

> >

> > Sorry I didn't get the chance to shoot this email over yesterday-it was a

> > classic crazy Monday. In case you do get the chance to confer with any of your

> > friends or present the case about my unsolved leg-pain mystery, here's the

> > reader's digest version of the case history:

> > -first started feeling consistent pain in March, 2009 when I began to run 3+

> > times per week. Pain can be sharp and stabbing around my medial calf muscle or

> > throbbing (like a bad bruise constantly being pushed on). If I push through

> > the pain, I tend to have residual pain even after stopping the activity. I

> > Initially thought the pain was associated with muscle fatigue from starting a

> > new exercise regime, but began to suspect shin splints when 2 months passed

> > with no improvement.

> > -Since beginning of pain, I have tried just about every form of conservative

> > pain management with no success: rest (up to 2 months), ice, arch taping, hard

> > orthotics (not specifically fitted to me though), massage, etc

> > -First saw a sports med Dr. in spring of 2010. He recommended PT with ASTYM to

> > treat what he thought was posterior tibial tendon dysfunction and possibly bad

> > shin splints (what you and I were talking about at bootcamp-with the hard

> > plastic tools that are " massaged " along the painful areas) and I followed

> > through with 10 weeks of ASTYM PT. I saw no improvement. At that point I was

> > told I most likely had compartment syndrome, since shin splints and tendinitis

> > should have improved at least a little with that amount and type of treatment.

> > -saw an ortho surgeon to discuss compartment pressure testing and she referred

> > me to another ortho who specializes in foot and ankle because she still

> > suspected posterior tibial tendon dysfunction. An MRI showed definite

> > fluid/inflammation around the tendon, so the tendon dysfunction was confirmed.

> > Still, she wanted testing done for compartment syndrome because she thought it

> > was extremely odd that tendon inflammation would cause such consistent

> > localized pain in the medial calf, and thought I might also have compartment

> > syndrome on top of the tendon problem.

> > -Compartment pressure testing was done a few weeks ago and showed normal

> > pressure in the medial calf.

> >

> > So now I'm back to square one. We know I have posterior tibial tendon

> > dysfunction that presents in an odd way. Unfortunately, I'm not any closer to

> > being pain-free when I do any kind of activity that involves the tendon. The

> > most recent recommendation was a steroid injection, possibly accompanied by a

> > boot to completely " rest " the tendon for ~6 weeks. This would then be followed

> > by PT to try to rebuild the muscles around the tendon so they can alleviate

> > some of what has caused the tendon to become inflamed in the first place...I

> > think. The goal is to get me " better " before I leave for my backpacking trip

> > to South America in mid-June.

> >

> > I'm always open to hearing suggestions about the whole scenario, so thanks for

> > all your ideas thus far!!!!!

> >

> > Let me know if you could use any other info!

> >

> ------ End of Forwarded Message

>

2 of 2 Photo(s)

IMG_3203.jpg

[Guest guest]

Painfree after one visit...Beam me up y, there are intelligent life forms on this planet.Great work.Dr. Todd Turnbull, DCOn Apr 11, 2011, at 1:21 PM, Abrahamson <drscott@...> wrote:

OK, so I get the x-rays from 07 which were taken after the fall on her coccyx and enclosed them here.

As you can see, her pelvis is torqued with all sorts of distortions.

Rookie doctors will always ASSUME that the distortions are from her recent trauma and pain causing splinting spasms.

Old geezers will withhold judgment and ask if the distortion pre-existed the injury.

(“It is better to keep your mouth shut and appear stupid than to open it and remove all doubt.†---Mark Twain)

This is a typical supine medical x-ray so we can’t see the ground impact of leg length disparity.

(Taken in Costa Rica but could we have a name marker and ovary shields please? This is the 21st century mi amigos!) Thanks for the date but what does “RB†mean?

Anyway, note that the pubic symphysis is asymmetrical.

....and what the heck are the two metallic pin or staple appearing opacities (patient doesn’t know; probably clothing). The opacity on the right is clearly an artifact.

Interestingly, I didn’t treat the actual painful calf but everything else around it (navicular adjustment, tape, pelvis adjustment).

Update: not to get too excited, but she is 3 days post adjustment and did the workout class this morning and is pain free!

She isn’t running so her exercise is milder.

The Elastikon tape is probably helping as it supports the arch while at rest.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: Abrahamson <drscott@...>

Date: Fri, 08 Apr 2011 13:14:38 -0700

Abrahamson <drscott@...>, "Dr. Todd Turnbull, DC" <drt@...>, < >

Subject: Re: Leg pain info- Suggestions- follow up...

This is the 23 year old athletic female with Tibialis posterior pain; BAD pain.

Yelling out loud pain. Don’t touch my leg pain!

While talking with her after class Dr. Devine happened to be listening in and recommended addressing her pelvis distortion. He then pointed at me and said “He will take care of you.†Classy guy.

She came in today for an exam and her calf was excruciatingly painful to light pressure. Her history revealed that she had fractured her tail bone while hiking in Central America 2-3 years ago, had to hike out 2 miles and ride six hours in a car to the help. Her host family included a medical doctor who took x-rays revealing a severely distorted pelvis and a fractured tailbone. The doctor said her tailbone and she recovered without therapy. I’ll share the x-ray when she brings it in.

Examination revealed a long-standing right posterior inferior ileum, tight hamstring muscles on the right. She also mentioned that she has had three bouts of severe sciatica which have responded slowly to acupuncture, ice, and time. She said that she was reticent to see a chiropractor because she was adjusted at 11 years old in Utah and the chiropractor dropped on her like a ton of bricks. (What’s up with that?)

Consulting with Dr. Domby who is a diplomate in applied kinesiology and a lifelong runner, he is convinced that strengthening the muscles will address arch distortion issues. He has cured tons of people addressing muscle strength and prescribing barefoot shoes.

When questioned further about the exact nature of her rehabilitation, the patient described a sort of leg sled device to perform an exercise called “blast offs†where she would thrust her legs and feet in an explosive manner to mimic the contraction necessary to support the arch in running.

I was wondering if the therapist’s attempt to mimic the sudden contractions necessary to support the arch aren’t actually the very exercises which continued to tear the muscles. Obviously, a sudden explosive contraction under strain is a recipe for straining already fragile muscles. Maybe the patient should have been exercising in a slow sustained manner until her muscles were strong enough to move up to the ballistic level. I was also thinking that she might be a good candidate for swimming with swim fins as it provides a brutal amount of exercise and is extremely safe.

I adjusted her pelvis which moved easily, [Of course, I’m an excellent adjuster. -Chiropractic Rain Man] adjusted her proximal tibia, her navicular, grabbed a handful of dorsal’s [ala Dick Stober] and of course adjusted her neck. I wrapped Elastikon tape (WAY stronger than Kinesiotape, but still stretchy) around her foot from the medial arch over the top, around the bottom, and up the medial posterior calf to mimic the extrinsic foot muscles. I backed it up with another length of tape, and anchored at the top. I instructed the patient to leave it on until Monday when I see her again.

I will keep you posted and if chiropractic helps her, we might make it into the best practices guidelines some day.

Your thoughts are always welcome.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: Abrahamson <drscott@...>

Date: Wed, 06 Apr 2011 08:34:16 -0700

"Dr. Todd Turnbull, DC" <drt@...>, < >

Subject: Re: Re: Leg pain info- Suggestions?

Well, I just met her at a workout class so I wasn’t able to muscle test.

I’m trying to get her in for a series of pelvis adjustments.

I heard somewhere that adjusting the pelvis can affect the foot.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: "Dr. Todd Turnbull, DC" <drt@...>

Date: Wed, 06 Apr 2011 06:23:37 -0000

< >

Subject: Re: Leg pain info- Suggestions?

,

What does muscle testing reveal?

Has she been tested for soleus, gastroc and flexor hallicus longus?Also inferior pubis and adductor issues can refer into the lower leg.

Dr. Todd Turnbull, DC

5223 NE Sandy Blvd

Portland, OR 97213

503-8053865

>

> I met a young gal at a boot camp class who had recently been tested for

> compartment syndrome. She clearly has tibialis posterior pain so I was

> wondering what the current conventional wisdom is regarding this.

>

> One theory holds that pronation causes the tibialis posterior muscle to

> attempt to raise the arch and frequently strains the muscle. Lifting the

> arches with orthotics cushions the collapse of the arch in mid step thus

> protecting the muscle.

>

> It appears in reading “Born to Runâ€, that shoes and orthotics are making

> runner's feet weaker thus ushering in the concept of barefoot running. This

> is supposed to allow the intrinsic and extrinsic foot muscles to regain

> strength so that we can run well into old age like our meat eating, grain

> avoiding, healthy as a pin, celiac-free ancestors! Of course, if the muscles

> are already strained there is going to have to be a rehab. period, but

> then, look out prey, here come de predator!

>

> Currently, as you can tell from the attached description, this gal is now

> experiencing pain from even mild activity. It's certainly interesting to see

> how the sports medicine world reveals itself by observing their progression

> of care.

>

> Suggestions?

>

> E. Abrahamson, D.C.

> Chiropractic physician

> Lake Oswego Chiropractic Clinic

> 315 Second Street

> Lake Oswego, OR 97034

> 503-635-6246

> Website: http://www.lakeoswegochiro.com

>

> ------ Forwarded Message

>

> >

> > Hi !

> >

> > Sorry I didn't get the chance to shoot this email over yesterday-it was a

> > classic crazy Monday. In case you do get the chance to confer with any of your

> > friends or present the case about my unsolved leg-pain mystery, here's the

> > reader's digest version of the case history:

> > -first started feeling consistent pain in March, 2009 when I began to run 3+

> > times per week. Pain can be sharp and stabbing around my medial calf muscle or

> > throbbing (like a bad bruise constantly being pushed on). If I push through

> > the pain, I tend to have residual pain even after stopping the activity. I

> > Initially thought the pain was associated with muscle fatigue from starting a

> > new exercise regime, but began to suspect shin splints when 2 months passed

> > with no improvement.

> > -Since beginning of pain, I have tried just about every form of conservative

> > pain management with no success: rest (up to 2 months), ice, arch taping, hard

> > orthotics (not specifically fitted to me though), massage, etc

> > -First saw a sports med Dr. in spring of 2010. He recommended PT with ASTYM to

> > treat what he thought was posterior tibial tendon dysfunction and possibly bad

> > shin splints (what you and I were talking about at bootcamp-with the hard

> > plastic tools that are "massaged" along the painful areas) and I followed

> > through with 10 weeks of ASTYM PT. I saw no improvement. At that point I was

> > told I most likely had compartment syndrome, since shin splints and tendinitis

> > should have improved at least a little with that amount and type of treatment.

> > -saw an ortho surgeon to discuss compartment pressure testing and she referred

> > me to another ortho who specializes in foot and ankle because she still

> > suspected posterior tibial tendon dysfunction. An MRI showed definite

> > fluid/inflammation around the tendon, so the tendon dysfunction was confirmed.

> > Still, she wanted testing done for compartment syndrome because she thought it

> > was extremely odd that tendon inflammation would cause such consistent

> > localized pain in the medial calf, and thought I might also have compartment

> > syndrome on top of the tendon problem.

> > -Compartment pressure testing was done a few weeks ago and showed normal

> > pressure in the medial calf.

> >

> > So now I'm back to square one. We know I have posterior tibial tendon

> > dysfunction that presents in an odd way. Unfortunately, I'm not any closer to

> > being pain-free when I do any kind of activity that involves the tendon. The

> > most recent recommendation was a steroid injection, possibly accompanied by a

> > boot to completely "rest" the tendon for ~6 weeks. This would then be followed

> > by PT to try to rebuild the muscles around the tendon so they can alleviate

> > some of what has caused the tendon to become inflamed in the first place...I

> > think. The goal is to get me "better" before I leave for my backpacking trip

> > to South America in mid-June.

> >

> > I'm always open to hearing suggestions about the whole scenario, so thanks for

> > all your ideas thus far!!!!!

> >

> > Let me know if you could use any other info!

> >

> ------ End of Forwarded Message

>

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[Guest guest]

Cautiously optimistic.

Will let you know when she tries running.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: todd turnbull <drt@...>

Date: Mon, 11 Apr 2011 16:48:57 -0700

Abrahamson <drscott@...>

Cc: Abrahamson <drscott@...>, " < > " < >

Subject: Re: Re: Leg pain info- Suggestions- follow up...+ x-rays

Painfree after one visit...Beam me up y, there are intelligent life forms on this planet.

Great work.

Dr. Todd Turnbull, DC

On Apr 11, 2011, at 1:21 PM, Abrahamson <drscott@...> wrote:

OK, so I get the x-rays from 07 which were taken after the fall on her coccyx and enclosed them here.

As you can see, her pelvis is torqued with all sorts of distortions.

Rookie doctors will always ASSUME that the distortions are from her recent trauma and pain causing splinting spasms.

Old geezers will withhold judgment and ask if the distortion pre-existed the injury.

(“It is better to keep your mouth shut and appear stupid than to open it and remove all doubt.” ---Mark Twain)

This is a typical supine medical x-ray so we can’t see the ground impact of leg length disparity.

(Taken in Costa Rica but could we have a name marker and ovary shields please? This is the 21st century mi amigos!) Thanks for the date but what does “RB” mean?

Anyway, note that the pubic symphysis is asymmetrical.

....and what the heck are the two metallic pin or staple appearing opacities (patient doesn’t know; probably clothing). The opacity on the right is clearly an artifact.

Interestingly, I didn’t treat the actual painful calf but everything else around it (navicular adjustment, tape, pelvis adjustment).

Update: not to get too excited, but she is 3 days post adjustment and did the workout class this morning and is pain free!

She isn’t running so her exercise is milder.

The Elastikon tape is probably helping as it supports the arch while at rest.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com <http://www.lakeoswegochiro.com>

From: Abrahamson <drscott@... <mailto:drscott@...> >

Date: Fri, 08 Apr 2011 13:14:38 -0700

Abrahamson <drscott@... <mailto:drscott@...> >, " Dr. Todd Turnbull, DC " <drt@... <mailto:drt@...> >, < <mailto: > >

Subject: Re: Leg pain info- Suggestions- follow up...

This is the 23 year old athletic female with Tibialis posterior pain; BAD pain.

Yelling out loud pain. Don’t touch my leg pain!

While talking with her after class Dr. Devine happened to be listening in and recommended addressing her pelvis distortion. He then pointed at me and said “He will take care of you.” Classy guy.

She came in today for an exam and her calf was excruciatingly painful to light pressure. Her history revealed that she had fractured her tail bone while hiking in Central America 2-3 years ago, had to hike out 2 miles and ride six hours in a car to the help. Her host family included a medical doctor who took x-rays revealing a severely distorted pelvis and a fractured tailbone. The doctor said her tailbone and she recovered without therapy. I’ll share the x-ray when she brings it in.

Examination revealed a long-standing right posterior inferior ileum, tight hamstring muscles on the right. She also mentioned that she has had three bouts of severe sciatica which have responded slowly to acupuncture, ice, and time. She said that she was reticent to see a chiropractor because she was adjusted at 11 years old in Utah and the chiropractor dropped on her like a ton of bricks. (What’s up with that?)

Consulting with Dr. Domby who is a diplomate in applied kinesiology and a lifelong runner, he is convinced that strengthening the muscles will address arch distortion issues. He has cured tons of people addressing muscle strength and prescribing barefoot shoes.

When questioned further about the exact nature of her rehabilitation, the patient described a sort of leg sled device to perform an exercise called “blast offs” where she would thrust her legs and feet in an explosive manner to mimic the contraction necessary to support the arch in running.

I was wondering if the therapist’s attempt to mimic the sudden contractions necessary to support the arch aren’t actually the very exercises which continued to tear the muscles. Obviously, a sudden explosive contraction under strain is a recipe for straining already fragile muscles. Maybe the patient should have been exercising in a slow sustained manner until her muscles were strong enough to move up to the ballistic level. I was also thinking that she might be a good candidate for swimming with swim fins as it provides a brutal amount of exercise and is extremely safe.

I adjusted her pelvis which moved easily, [Of course, I’m an excellent adjuster. -Chiropractic Rain Man] adjusted her proximal tibia, her navicular, grabbed a handful of dorsal’s [ala Dick Stober] and of course adjusted her neck. I wrapped Elastikon tape (WAY stronger than Kinesiotape, but still stretchy) around her foot from the medial arch over the top, around the bottom, and up the medial posterior calf to mimic the extrinsic foot muscles. I backed it up with another length of tape, and anchored at the top. I instructed the patient to leave it on until Monday when I see her again.

I will keep you posted and if chiropractic helps her, we might make it into the best practices guidelines some day.

Your thoughts are always welcome.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com <http://www.lakeoswegochiro.com>

From: Abrahamson <drscott@... <mailto:drscott@...> >

Date: Wed, 06 Apr 2011 08:34:16 -0700

" Dr. Todd Turnbull, DC " <drt@... <mailto:drt@...> >, < <mailto: > >

Subject: Re: Re: Leg pain info- Suggestions?

Well, I just met her at a workout class so I wasn’t able to muscle test.

I’m trying to get her in for a series of pelvis adjustments.

I heard somewhere that adjusting the pelvis can affect the foot.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com <http://www.lakeoswegochiro.com>

From: " Dr. Todd Turnbull, DC " <drt@... <mailto:drt@...> >

Date: Wed, 06 Apr 2011 06:23:37 -0000

< <mailto: > >

Subject: Re: Leg pain info- Suggestions?

,

What does muscle testing reveal?

Has she been tested for soleus, gastroc and flexor hallicus longus?Also inferior pubis and adductor issues can refer into the lower leg.

Dr. Todd Turnbull, DC

5223 NE Sandy Blvd

Portland, OR 97213

503-8053865

>

> I met a young gal at a boot camp class who had recently been tested for

> compartment syndrome. She clearly has tibialis posterior pain so I was

> wondering what the current conventional wisdom is regarding this.

>

> One theory holds that pronation causes the tibialis posterior muscle to

> attempt to raise the arch and frequently strains the muscle. Lifting the

> arches with orthotics cushions the collapse of the arch in mid step thus

> protecting the muscle.

>

> It appears in reading “Born to Run”, that shoes and orthotics are making

> runner's feet weaker thus ushering in the concept of barefoot running. This

> is supposed to allow the intrinsic and extrinsic foot muscles to regain

> strength so that we can run well into old age like our meat eating, grain

> avoiding, healthy as a pin, celiac-free ancestors! Of course, if the muscles

> are already strained there is going to have to be a rehab. period, but

> then, look out prey, here come de predator!

>

> Currently, as you can tell from the attached description, this gal is now

> experiencing pain from even mild activity. It's certainly interesting to see

> how the sports medicine world reveals itself by observing their progression

> of care.

>

> Suggestions?

>

> E. Abrahamson, D.C.

> Chiropractic physician

> Lake Oswego Chiropractic Clinic

> 315 Second Street

> Lake Oswego, OR 97034

> 503-635-6246

> Website: http://www.lakeoswegochiro.com <http://www.lakeoswegochiro.com>

>

> ------ Forwarded Message

>

> >

> > Hi !

> >

> > Sorry I didn't get the chance to shoot this email over yesterday-it was a

> > classic crazy Monday. In case you do get the chance to confer with any of your

> > friends or present the case about my unsolved leg-pain mystery, here's the

> > reader's digest version of the case history:

> > -first started feeling consistent pain in March, 2009 when I began to run 3+

> > times per week. Pain can be sharp and stabbing around my medial calf muscle or

> > throbbing (like a bad bruise constantly being pushed on). If I push through

> > the pain, I tend to have residual pain even after stopping the activity. I

> > Initially thought the pain was associated with muscle fatigue from starting a

> > new exercise regime, but began to suspect shin splints when 2 months passed

> > with no improvement.

> > -Since beginning of pain, I have tried just about every form of conservative

> > pain management with no success: rest (up to 2 months), ice, arch taping, hard

> > orthotics (not specifically fitted to me though), massage, etc

> > -First saw a sports med Dr. in spring of 2010. He recommended PT with ASTYM to

> > treat what he thought was posterior tibial tendon dysfunction and possibly bad

> > shin splints (what you and I were talking about at bootcamp-with the hard

> > plastic tools that are " massaged " along the painful areas) and I followed

> > through with 10 weeks of ASTYM PT. I saw no improvement. At that point I was

> > told I most likely had compartment syndrome, since shin splints and tendinitis

> > should have improved at least a little with that amount and type of treatment.

> > -saw an ortho surgeon to discuss compartment pressure testing and she referred

> > me to another ortho who specializes in foot and ankle because she still

> > suspected posterior tibial tendon dysfunction. An MRI showed definite

> > fluid/inflammation around the tendon, so the tendon dysfunction was confirmed.

> > Still, she wanted testing done for compartment syndrome because she thought it

> > was extremely odd that tendon inflammation would cause such consistent

> > localized pain in the medial calf, and thought I might also have compartment

> > syndrome on top of the tendon problem.

> > -Compartment pressure testing was done a few weeks ago and showed normal

> > pressure in the medial calf.

> >

> > So now I'm back to square one. We know I have posterior tibial tendon

> > dysfunction that presents in an odd way. Unfortunately, I'm not any closer to

> > being pain-free when I do any kind of activity that involves the tendon. The

> > most recent recommendation was a steroid injection, possibly accompanied by a

> > boot to completely " rest " the tendon for ~6 weeks. This would then be followed

> > by PT to try to rebuild the muscles around the tendon so they can alleviate

> > some of what has caused the tendon to become inflamed in the first place...I

> > think. The goal is to get me " better " before I leave for my backpacking trip

> > to South America in mid-June.

> >

> > I'm always open to hearing suggestions about the whole scenario, so thanks for

> > all your ideas thus far!!!!!

> >

> > Let me know if you could use any other info!

> >

> ------ End of Forwarded Message

>

Reply to sender <mailto:drscott@...?subject=Re%3A%20Leg%20pain%20info-%20Suggestions-%20follow%20up%2E%2E%2E <mailto:drscott@...?subject=Re%3A%20Leg%20pain%20info-%20Suggestions-%20follow%20up%2E%2E%2E> > | Reply to group <mailto: ?subject=Re%3A%20Leg%20pain%20info-%20Suggestions-%20follow%20up%2E%2E%2E <mailto: ?subject=Re%3A%20Leg%20pain%20info-%20Suggestions-%20follow%20up%2E%2E%2E> > | Reply via web post </post;_ylc=X3oDMTJxYzhkcGZvBF9TAzk3MzU5NzE0BGdycElkAzE0MDU5MjAEZ3Jwc3BJZAMxNzA1MDYxMTQ2BG1zZ0lkAzQwOTY5BHNlYwNmdHIEc2xrA3JwbHkEc3RpbWUDMTMwMjI5MzY5MA--?act=reply & messageNum=40969 </post;_ylc=X3oDMTJxYzhkcGZvBF9TAzk3MzU5NzE0BGdycElkAzE0MDU5MjAEZ3Jwc3BJZAMxNzA1MDYxMTQ2BG1zZ0lkAzQwOTY5BHNlYwNmdHIEc2xrA3JwbHkEc3RpbWUDMTMwMjI5MzY5MA--?act=reply & messageNum=40969> > | Start a New Topic </post;_ylc=X3oDMTJlYWNzN3V2BF9TAzk3MzU5NzE0BGdycElkAzE0MDU5MjAEZ3Jwc3BJZAMxNzA1MDYxMTQ2BHNlYwNmdHIEc2xrA250cGMEc3RpbWUDMTMwMjI5MzY5MA-- </post;_ylc=X3oDMTJlYWNzN3V2BF9TAzk3MzU5NzE0BGdycElkAzE0MDU5MjAEZ3Jwc3BJZAMxNzA1MDYxMTQ2BHNlYwNmdHIEc2xrA250cGMEc3RpbWUDMTMwMjI5MzY5MA--> >

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<IMG_3203.jpg>

[Guest guest]

I thought I would share the taping I made up for the patient with me posterior shin splints. She is improving but like most athletes, she pushes herself too hard and keeps reinjuring herself. She really tries to take it easy but when you are used to pushing through pain, easy is an adversary.

I have enclosed the pictures for taping the tibia Alice posterior or flexor due to tour him longer if. (Tibialis posterior and flexor digitorum longus interpreted by Dragon Dictation).

The Elastikon tape is cheaper and more durable than Kinesio tape. It is stickier than fly paper so be careful.

http://www.scriphessco.com/products/elastikon-elastic-self-adhering-tape/

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: Abrahamson <drscott@...>

Date: Mon, 11 Apr 2011 18:14:57 -0700

todd turnbull <drt@...>

Cc: " < > " < >

Subject: Re: Re: Leg pain info- Suggestions- follow up...+ x-rays

Cautiously optimistic.

Will let you know when she tries running.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: todd turnbull <drt@...>

Date: Mon, 11 Apr 2011 16:48:57 -0700

Abrahamson <drscott@...>

Cc: Abrahamson <drscott@...>, " < > " < >

Subject: Re: Re: Leg pain info- Suggestions- follow up...+ x-rays

Painfree after one visit...Beam me up y, there are intelligent life forms on this planet.

Great work.

Dr. Todd Turnbull, DC

On Apr 11, 2011, at 1:21 PM, Abrahamson <drscott@...> wrote:

OK, so I get the x-rays from 07 which were taken after the fall on her coccyx and enclosed them here.

As you can see, her pelvis is torqued with all sorts of distortions.

Rookie doctors will always ASSUME that the distortions are from her recent trauma and pain causing splinting spasms.

Old geezers will withhold judgment and ask if the distortion pre-existed the injury.

(“It is better to keep your mouth shut and appear stupid than to open it and remove all doubt.” ---Mark Twain)

This is a typical supine medical x-ray so we can’t see the ground impact of leg length disparity.

(Taken in Costa Rica but could we have a name marker and ovary shields please? This is the 21st century mi amigos!) Thanks for the date but what does “RB” mean?

Anyway, note that the pubic symphysis is asymmetrical.

....and what the heck are the two metallic pin or staple appearing opacities (patient doesn’t know; probably clothing). The opacity on the right is clearly an artifact.

Interestingly, I didn’t treat the actual painful calf but everything else around it (navicular adjustment, tape, pelvis adjustment).

Update: not to get too excited, but she is 3 days post adjustment and did the workout class this morning and is pain free!

She isn’t running so her exercise is milder.

The Elastikon tape is probably helping as it supports the arch while at rest.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com <http://www.lakeoswegochiro.com>

From: Abrahamson <drscott@... <mailto:drscott@...> >

Date: Fri, 08 Apr 2011 13:14:38 -0700

Abrahamson <drscott@... <mailto:drscott@...> >, " Dr. Todd Turnbull, DC " <drt@... <mailto:drt@...> >, < <mailto: > >

Subject: Re: Leg pain info- Suggestions- follow up...

This is the 23 year old athletic female with Tibialis posterior pain; BAD pain.

Yelling out loud pain. Don’t touch my leg pain!

While talking with her after class Dr. Devine happened to be listening in and recommended addressing her pelvis distortion. He then pointed at me and said “He will take care of you.” Classy guy.

She came in today for an exam and her calf was excruciatingly painful to light pressure. Her history revealed that she had fractured her tail bone while hiking in Central America 2-3 years ago, had to hike out 2 miles and ride six hours in a car to the help. Her host family included a medical doctor who took x-rays revealing a severely distorted pelvis and a fractured tailbone. The doctor said her tailbone and she recovered without therapy. I’ll share the x-ray when she brings it in.

Examination revealed a long-standing right posterior inferior ileum, tight hamstring muscles on the right. She also mentioned that she has had three bouts of severe sciatica which have responded slowly to acupuncture, ice, and time. She said that she was reticent to see a chiropractor because she was adjusted at 11 years old in Utah and the chiropractor dropped on her like a ton of bricks. (What’s up with that?)

Consulting with Dr. Domby who is a diplomate in applied kinesiology and a lifelong runner, he is convinced that strengthening the muscles will address arch distortion issues. He has cured tons of people addressing muscle strength and prescribing barefoot shoes.

When questioned further about the exact nature of her rehabilitation, the patient described a sort of leg sled device to perform an exercise called “blast offs” where she would thrust her legs and feet in an explosive manner to mimic the contraction necessary to support the arch in running.

I was wondering if the therapist’s attempt to mimic the sudden contractions necessary to support the arch aren’t actually the very exercises which continued to tear the muscles. Obviously, a sudden explosive contraction under strain is a recipe for straining already fragile muscles. Maybe the patient should have been exercising in a slow sustained manner until her muscles were strong enough to move up to the ballistic level. I was also thinking that she might be a good candidate for swimming with swim fins as it provides a brutal amount of exercise and is extremely safe.

I adjusted her pelvis which moved easily, [Of course, I’m an excellent adjuster. -Chiropractic Rain Man] adjusted her proximal tibia, her navicular, grabbed a handful of dorsal’s [ala Dick Stober] and of course adjusted her neck. I wrapped Elastikon tape (WAY stronger than Kinesiotape, but still stretchy) around her foot from the medial arch over the top, around the bottom, and up the medial posterior calf to mimic the extrinsic foot muscles. I backed it up with another length of tape, and anchored at the top. I instructed the patient to leave it on until Monday when I see her again.

I will keep you posted and if chiropractic helps her, we might make it into the best practices guidelines some day.

Your thoughts are always welcome.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com <http://www.lakeoswegochiro.com>

From: Abrahamson <drscott@... <mailto:drscott@...> >

Date: Wed, 06 Apr 2011 08:34:16 -0700

" Dr. Todd Turnbull, DC " <drt@... <mailto:drt@...> >, < <mailto: > >

Subject: Re: Re: Leg pain info- Suggestions?

Well, I just met her at a workout class so I wasn’t able to muscle test.

I’m trying to get her in for a series of pelvis adjustments.

I heard somewhere that adjusting the pelvis can affect the foot.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com <http://www.lakeoswegochiro.com>

From: " Dr. Todd Turnbull, DC " <drt@... <mailto:drt@...> >

Date: Wed, 06 Apr 2011 06:23:37 -0000

< <mailto: > >

Subject: Re: Leg pain info- Suggestions?

,

What does muscle testing reveal?

Has she been tested for soleus, gastroc and flexor hallicus longus?Also inferior pubis and adductor issues can refer into the lower leg.

Dr. Todd Turnbull, DC

5223 NE Sandy Blvd

Portland, OR 97213

503-8053865

>

> I met a young gal at a boot camp class who had recently been tested for

> compartment syndrome. She clearly has tibialis posterior pain so I was

> wondering what the current conventional wisdom is regarding this.

>

> One theory holds that pronation causes the tibialis posterior muscle to

> attempt to raise the arch and frequently strains the muscle. Lifting the

> arches with orthotics cushions the collapse of the arch in mid step thus

> protecting the muscle.

>

> It appears in reading “Born to Run”, that shoes and orthotics are making

> runner's feet weaker thus ushering in the concept of barefoot running. This

> is supposed to allow the intrinsic and extrinsic foot muscles to regain

> strength so that we can run well into old age like our meat eating, grain

> avoiding, healthy as a pin, celiac-free ancestors! Of course, if the muscles

> are already strained there is going to have to be a rehab. period, but

> then, look out prey, here come de predator!

>

> Currently, as you can tell from the attached description, this gal is now

> experiencing pain from even mild activity. It's certainly interesting to see

> how the sports medicine world reveals itself by observing their progression

> of care.

>

> Suggestions?

>

> E. Abrahamson, D.C.

> Chiropractic physician

> Lake Oswego Chiropractic Clinic

> 315 Second Street

> Lake Oswego, OR 97034

> 503-635-6246

> Website: http://www.lakeoswegochiro.com <http://www.lakeoswegochiro.com>

>

> ------ Forwarded Message

>

> >

> > Hi !

> >

> > Sorry I didn't get the chance to shoot this email over yesterday-it was a

> > classic crazy Monday. In case you do get the chance to confer with any of your

> > friends or present the case about my unsolved leg-pain mystery, here's the

> > reader's digest version of the case history:

> > -first started feeling consistent pain in March, 2009 when I began to run 3+

> > times per week. Pain can be sharp and stabbing around my medial calf muscle or

> > throbbing (like a bad bruise constantly being pushed on). If I push through

> > the pain, I tend to have residual pain even after stopping the activity. I

> > Initially thought the pain was associated with muscle fatigue from starting a

> > new exercise regime, but began to suspect shin splints when 2 months passed

> > with no improvement.

> > -Since beginning of pain, I have tried just about every form of conservative

> > pain management with no success: rest (up to 2 months), ice, arch taping, hard

> > orthotics (not specifically fitted to me though), massage, etc

> > -First saw a sports med Dr. in spring of 2010. He recommended PT with ASTYM to

> > treat what he thought was posterior tibial tendon dysfunction and possibly bad

> > shin splints (what you and I were talking about at bootcamp-with the hard

> > plastic tools that are " massaged " along the painful areas) and I followed

> > through with 10 weeks of ASTYM PT. I saw no improvement. At that point I was

> > told I most likely had compartment syndrome, since shin splints and tendinitis

> > should have improved at least a little with that amount and type of treatment.

> > -saw an ortho surgeon to discuss compartment pressure testing and she referred

> > me to another ortho who specializes in foot and ankle because she still

> > suspected posterior tibial tendon dysfunction. An MRI showed definite

> > fluid/inflammation around the tendon, so the tendon dysfunction was confirmed.

> > Still, she wanted testing done for compartment syndrome because she thought it

> > was extremely odd that tendon inflammation would cause such consistent

> > localized pain in the medial calf, and thought I might also have compartment

> > syndrome on top of the tendon problem.

> > -Compartment pressure testing was done a few weeks ago and showed normal

> > pressure in the medial calf.

> >

> > So now I'm back to square one. We know I have posterior tibial tendon

> > dysfunction that presents in an odd way. Unfortunately, I'm not any closer to

> > being pain-free when I do any kind of activity that involves the tendon. The

> > most recent recommendation was a steroid injection, possibly accompanied by a

> > boot to completely " rest " the tendon for ~6 weeks. This would then be followed

> > by PT to try to rebuild the muscles around the tendon so they can alleviate

> > some of what has caused the tendon to become inflamed in the first place...I

> > think. The goal is to get me " better " before I leave for my backpacking trip

> > to South America in mid-June.

> >

> > I'm always open to hearing suggestions about the whole scenario, so thanks for

> > all your ideas thus far!!!!!

> >

> > Let me know if you could use any other info!

> >

> ------ End of Forwarded Message

>

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