‘Step Outside the Foot’ Perry Nickelston, DC, FMS, SFMA Pain Laser Center, LLC
Jun 01, 2015
‘Step Outside the Foot’
Perry Nickelston, DC, FMS, SFMAPain Laser Center, LLC
Case Study
Plantar Fasciitis ?
Assessment/Evaluations
Treatment Protocols
Grassroots branding
35 year old female runnerPain on bottom of right foot and heel8-months
*Podiatrist (orthotics)*Physical Therapy (US, stim, exercise)*Chiropractic*Cortisone injections (2)
Insanity- ‘Doing the same thing over and over expecting a different result.’
MOVEMENT DYSFUNCTION Joint by joint kinematic chain Mobility, stability, muscle activation
Site vs. Source Treat both parametersLaser…functional movement…
“The physician arrives at a diagnosis not from the evidence furnished by one painful movement but by careful determination of a consistent pattern.”
-Dr. James Cyriax
Multi-Segmental Flexion Multi-Segmental Extension Multi-Segmental Rotation Single Leg Stance Squatting Pattern Upper Extremity Movement Patterns Cervical Movement Patterns
Each assessment of the SFMA must be scored with one of four possible answers:
1. Functional and Non-Painful (FN)
2. Functional and Painful (FP)
3. Dysfunctional and Painful (DP)
4. Dysfunctional and Non-Painful (DN)**
SCORING SYSTEM
*Dysfunctional does not always mean limited movement…..can also be an abnormal pattern, timing, or increased exertion.
KEY POINT
Don’t Chase PAIN
Traditional model attacks the inflamed tissue.
We want to find and treat the source of the pain using a systematic
examination.
Decreased ankle dorsi-flexion (B) R>L Decreased hip extension (R) Decreased hip internal rotation (B) Decreased T-Spine rotation (L) Decreased Cervical Spine Flexion/ (L)
rotation Decreased hip stability (L)
Spinal Fixations:Occiput…T12/L1…Sacral Apex
Trigger points Soleus, gastroc, tibialis
posterior/anterior, vastus medialis/lateralis, adductor longus/magnus, psoas,)
Hip Cuff (Medius/minimus,
piriformis, TFL, ITB, QL)
•Plantar•Sacrotuberous•Glutei Maximi Slip•Thoracolumbar•Suboccipital
*Lateral Line*Deep Frontal Line*Spiral Line
• Diagnosis
• Dosages per square area•Joules
• Application process
•Frequency of therapy
Photo-biostimulation
Cellular regeneration
1,000 J Thoracolumbar Fascia500J Suboccipital 500J L5/S11,000J (B) Hip1,500J Gastroc/Soleus1,500 J Plantar Surface
Settings: 10W CW 10 Min session 6 treatments 2x week / 3 Weeks
(MFR, Tp, ART)
Foam Rollers
Laser Therapy
Active Isolated Stretching
Mulligan (B) hips
Mulligan (B) ankles
Ankle mobility drills
Diversified Spinal
Glute activation DrillsMini-bands
Hip Extension Drills
MUSCLE ACTIVATION
Diaphragmatic Breathing
Diaphragm Release
Laser Therapy Diaphragm
T-Spine Rotation
How do you assess movement?
1. Squatting2. Stepping3. Lunging4. Reaching5. Leg raising6. Push-up7. Rotational stability
Eight laser treatments Class 4 Laser Ten sessions of soft tissue Six sessions of activation/stabilization Two sessions of breathing instruction
Released from care asymptomatic withinstructions on use of foam
roller/stretching.
Maintenance program every FOUR weeks.
Class 4 Laser Therapy
Movement Assessment
Mobility/Stability
Soft Tissue
Stop Chasing Pain
Why did she seek me out for care? RESULTS LASER UNIQUENESS
Workshop/Seminar evaluations for her running club. Runners know runners Plantar fasciitis knows…