When The Kneecap Goes Awry

The kneecap (patella), which is embedded in the tendon of the quadraceps (quads) muscle(s) on the front of the thigh, “tracks” in a groove on the front of the femur, or thigh bone. The quadraceps tendon attaches below the knee to the tibia.

As the knee bends back & forth, the kneecap, which effects a mechanical advantage of 30% increase in the power production of our quads, slides in the bony groove.

If the kneecap becomes misaligned, as it slides there is abnormal wear & tear against the groove, and this can be the beginning of arthritis in the knee. There may be an audible “crunch” in the knee with squats. 

As an Activator Chiropractor, I have an effective adjustment for this condition, and I give the patient exercises that will help the kneecap stay in alignment. 

5 Key Facts About the Shoulder

(1)  It is the most complex and most mobile part of the body.

(2)  It consists of 4 articulations---the glenohumeral joint (top of the arm connects at the shoulder), the sternoclavicular joint (the collarbone connects near the throat), the acromioclavicular joint (outer end of the collarbone connects with a bony projection off the shoulderblade, and the scapulothoracic articulation (the scapula, or shoulderblade, contacts the rear chest wall).          

(3)  Pain in the shoulder may not be a shoulder problem, but be referred pain from 3 common sites---the heart, the lungs, and the neck. 

(4)  Shoulder dislocation involving the humerus (bone in the upper arm) is common because of the shallowness of the “cup” holding the humeral head. 

 (5)   Bursitis is common in the shoulder, caused by inflammation due to repetitive motions (e.g. painting, drywalling, throwing sports).

Services Medicare Doesn't Cover

       As it currently stands for chiropractic services, Medicare only covers adjusting the spine.

No coverage is provided for extraspinal treatment, e.g., for knee, shoulder, wrist, ankle, etc., problems. This is expected to change; chiropractors anticipate Medicare will eventually cover extraspinal problems.

Other essential services provided by chiropractors, also not currently covered by Medicare, are exercises; supports; home care, nutritional, or ergonomic counseling; stretches; and supplements.

Your chiropractor may prescribe / provide these services for you because they are essential to resolving your problem(s), but Medicare will not reimburse; you are responsible for payment.

Sacral Vertebrae

  An occasional variant in the anatomy of the lower spine is the failure to fuze of the 1st sacral vertebra with its neighbor below.

This results in an additional vertebra inferior to L5, where normally the sacrum is one bone consisting of several fuzed, no longer separate, vertebrae.

In some patients with this anatomical variant, it presents no problems, whereas in others the anomaly creates a vulnerability to low back stresses. 

These patients may need more frequent intermittent spinal balancing to maintain comfort and normal function. 

Is It the Meniscus??

  Pain in the knee may be due to any one or more of various possible misalignments or articular aberrances. 

The knee is a hinge joint, and as such it is not meant to move in other than an approximate sagittal plane.

However, slight rotation of the tibia at the joint with the femur, posteriority or anteriority of the proximal tibia, misalignment of the fibula, medial or lateral tibial-femoral joint compression, etc., can occur. These aberrances, even to the slight extent of millimeter(s), can cause discomfort or affect the knee’s range of motion.

If pain persists after all the “usual suspects” of misalignments / aberrances are screened & corrected, an Activator chiropractor looks to the medial and / or lateral meniscus. Often a carefully-vectored Activator adjustment on the inside or outside of the knee solves the problem and stops the pain.

Unilateral Head Pain

  Pain on just one side of the head, in the jaw region or near the ear or cheekbone, can be a simple headache, a TMJ problem, or a dental issue.

However, for these patients it is important to include a condition called vasculitis in the list of possible diagnoses.

Vasculitis is an inflammation of blood vessels. When this occurs in the side, or temporal, region of the head, it is called “temporal arteritis,”  an inflammation in the temporal artery. There may be swelling as well as pain, and the area may be tender to the touch. Often there is a fever.

This is a serious condition, and can have serious consequences. It can spread to the blood vessels of the eyes and possibly cause blindness. If suspected, the patient should immediately be referred to an M.D.

Medicare--Allowed # of Visits

  Medicare typically allows 12 chiropractic treatments (visits) per year.

However, certain things that often go along with aging are considered by Medicare to justify an extended, or longer term, of chiropractic care.

These conditions, called “co-morbidities,” may complicate, or impede healing, making the number of treatments necessary to resolve a chiropractic problem greater.

A common co-morbidity is spinal disc degeneration, usually associated with spondylosis, or bony spur formation around vertebral edges. Another term for this is DJD, or degenerative joint disease. 

Sciatica, spinal stenosis (narrowing of the spinal canal), and foraminal encroachment (narrowing of the opening(s) where the nerves exit the spine) are also co-morbidities, as are health conditions which may complicate or impede healing such as diabetes and osteoporosis.