golf, extremities for chiropractors

Chiropractic for Golfers’ Extremities

BOATRIGHT CHIROPRACTIC

SEMINARS PRESENTS

Copyright © 2015 Richard Boatright, all rights reserved

DISCLAIMER

• This presentation is intended for chiropractors. It is not intended as a diagnosis for any

particular patient’s condition, nor is it a recommendation as treatment for any particular

patient. The chiropractor or other medical professional has complete responsibility for

evaluating the specifics of his or her patient and arriving at a rational diagnosis and

treatment program based on the doctor’s own training, scope of practice and licensure.


ABOUT THE PRESENTER

• Dr. Rick Boatright, D.C. has been a Certified Golf

Injury Doctor since 2007. He’s the current president

and owner of Boatright Chiropractic Seminars.

• Dr. B. was an instructor with Activator Methods for 7

years and nominated for Activator Chiropractor of the

Year in 1988 for his work with shoulder subluxations.

• He was one of the first doctors in the country to earn

an Advanced Proficiency rating with Activator

Methods.

• Dr. B. was the fourth doctor in Arizona to earn full

certification in the Impulse technique.

• He can identify and correct more than 150 different

extremity subluxations if you only count one side of

the body and count only one finger and one toe.


CONNECTIVE TISSUE / FASCIA

• A growing body of evidence shows that nerves are not the only communication system in the body

• Nor is nerve communication the fastest or most efficient means

• Research is demonstrating that connective tissue – fascia specifically – communicates throughout the body almost instantaneously.

• The fascia has proprioceptive qualities, so it’s directionally sensitive.

• It has tissue memory.

• The tissue memory can be changed with external stimuli such as high velocity thrusts, but only require minimal amplitude.


THIS ANSWERS SOME PERPLEXING

QUESTIONS:

• Patellae, sesamoid bones, move around in all directions, but we can “adjust” them. How does that work?

• Shoulder blades simply slide around on top of the rib cage, but we can adjust them. Is that taking a bone from point A to point B?

• We can adjust the head of the humerus, but it’s one of the sloppiest joints in the body. Why does adjusting it make any difference?

• Chiropractors effectively adjust HORSES with Activators. Those bones are HUGE!

• Is it a matter of “putting a bone back in place?”

• Only indirectly!

• It’s more likely an ADJUSTMENT in the body’s proprioceptive communication system.


WHY DIFFERENT TECHNIQUES WORK

• This can explain why Gonstead and

Activator both get good results.

• It can explain why Rolfing and deep tissue

massage make such great changes.

• It can explain why myofascial release

techniques work so well.

• In every case, the end result of the

adjustment, massage or manipulation is a

change in the fascial communication

system, a PROPRIOCEPTIVE function of

the body.

• Speed and direction are the language of

this communication system.


EXTREMITY ADJUSTING

• High – speed thrusts with an

instrument are extremely accurate,

pre-measured, non-traumatic and

scientifically reproducible.

• Corrective thrusts are extremely

easy to learn and apply.

• Lines of drive are extremely easy to

achieve regardless of the doctor’s or

patient’s body position.

• Every conceivable subluxation can

be addressed at any joint that is

physically accessible.


MATHEMATICAL LOGIC

• An equation in physics states that, “Weight times acceleration equals work.”

• Chiropractic adjusting instruments, like the Activator and the Impulse, deliver a thrust from 100 to 600 times faster than the fastest hand-delivered adjustment ever measured.

• In this equation, with this increase in speed, you can reduce the amount of push you have to put into the thrust by 100 to 600 times but still come out with the same amount of work in pounds per square inch.

• Instrument adjusting is like a hammer impact compared to a push by hand.


THE FOUR MOST COMMON GOLF

INJURIES

• Low back

• Knee

• Elbow

• Wrist


PROTECTION IS ALWAYS

COMMUNICATED

• Quadratus lumborum muscles connect

the rib cage to the pelvis

• One is always stronger than the other

• When the body feels threatened, it

protects itself by tensing up, including

contracting the QLs.

• When the QLs contract, the stronger one

pulls the iliac crest up higher, rotating the

pelvis and causing a leg to appear

shorter.

• This phenomenon only happens in a

protection mode so you know what to

work on and what to leave alone.


LOW BACK

• Chiropractic adjusting of the low

back can relieve the vast majority

of low back pain related to golf.

As chiropractors, that’s what you

do best! So we won’t spend any

time on this one.


THE KNEE

• The only medical complaint more common than

knee pain is back pain.

• There are four bones in the knee: Femur, tibia,

fibula and the patella.

• One of the most common causes of femoral-tibial

subluxations in golfers is failing to keep the back

knee facing forward during the back swing.

• However, subluxations can be found in either knee.

• There are six common subluxations to be found at

the femoral-tibial joint: Medial anterior, medial

posterior, lateral anterior, lateral posterior, straight

lateral and straight medial.


THE KNEE• To identify a subluxation, introduce a directional

stress into the joint and test the leg lengths. A short leg indicates a positive. Adjust in the opposite direction. No change means leave it alone and proceed to the next test.

• Press forward at the tibial plateau just below the joint. A short leg indicates an anteriority.

• Press posteriorly on the lateral side and then posteriorly on the medial side.

• The directional pressure that causes the legs to even out is the corrective line of drive you need. The contact point should be at or near the ligaments that attach the bones at the joint, to maximize fascial communication.

• With an Activator, use a single thrust. With an Impulse use from 3 to 6.

• Retest to ensure you got the correction.


THE KNEE• The tibial plateau can also subluxate posteriorly

on either side.

• Pull posteriorly at the tibial plateau. A short leg

indicates an posteriority. Press anteriorly on the

lateral side and anteriorly on the medial side.

• The directional pressure that causes the legs to

even out is the corrective line of drive you need.

The contact point should be at the ligaments that

attach the bones at the joint.

• With an Activator, use a single thrust. With an

Impulse, use from 3 to 6.

• Retest to ensure you got the correction.


THE KNEE

• Relative to the femur, the tibial plateau can subluxate lateral or medial. Stabilize the femur with one palm and press either laterally or medially on the tibial head.

• A leg length reaction indicates a positive in the direction you’re pushing.

• Correct it thrusting in the opposite direction. The contact point is on the lateral or medial aspect of the tibial plateau just inferior to the joint itself.

• Don’t think that what you see here today are the only subluxations in the knee. Use your intuition and the principle behind leg checks to test your theories as they arise.


THE FIBULA AT THE KNEE

• The head of the fibula attaches at the lateral aspect

of the tibial head.

• The peroneal nerve passes in close proximity to it.

• Nerve irritation here results in pain (often severe) in

the lateral knee, the lateral lower leg and the lateral

ankle.

• It is most often MIS diagnosed as sciatica!

• It can subluxate anterior, posterior, superior, inferior

or laterally. I’ve never seen one medial; however, it

doesn’t mean it will never happen.

• Corrective thrusts are in a line of drive opposite to the

identified subluxation, into the connecting ligaments.


THE FIBULA AT THE KNEE

I’ve had a number of patients come in on crutches

with knee pain from fibular subluxations. After the

first adjustment, they leave the crutches at home.

It’s a powerful adjustment!

• It can be the underlying cause of anterior

compartment syndrome.

• With an inversion sprain at the ankle an inferior

fibula nearly always shows up too!

• Any time you find a subluxation at this joint, be

sure to check the opposite end of the fibula at

the malleolus. There are two ends to every

bone!


THE PATELLA

• The patella is actually a sesamoid bone, an accessory bone within a ligament to help the joint beneath it to function more efficiently.

• A knee that doesn’t want to bend, for instance can indicate a “inferior” patella.

• I don’t believe that means that the bone has misplaced in a inferior direction, but rather, that inferior forces are out of balance with the superior forces.

• The key is to restore the balance. Stroke superior, inferior, lateral and medial to identify subluxations. Correct with thrusts in the opposite direction from subluxation.

• Also check for an anterior patella.


LASER THERAPY

• If you have an Erchonia 5000, program it

for either pain and inflammation

(arthritis), trauma, scarring or ligament

stability. Apply the programmable head

to the knee and the pre programmed to

L3 for 180 seconds. Ideally, have the

patient move the knee during therapy.

• If you have another laser, program it for

inflammation and apply according to your

protocols while the joint is in motion.

• Laser therapy, when used with every

adjustment, measurably accelerates

healing and stabilizes the healing sooner.


FOOT LEVELERS

• One of the most helpful things you can do

to support knee problems, especially

medial knee pain, is to fit your patient for

Foot Levelers.

• Eversion rotates the knee placing excess

stress on the medial knee. It also

stresses the ankle, the hip, low back and

up the spine.

• Foot Levelers also offers an amazing

orthotic called “Parflex” that’s guaranteed

to give the golfer an extra 9 to 15 yards

off the tee.

• My patients have reported better play all

around the course too.


THE ELBOW

• The elbow consists of three bones, the

humerus, the radius and the ulna.

• The radial head can subluxate medial, lateral

superior and inferior. Don’t let anybody

convince you otherwise. Check them all.

Correct in the direction opposite of the

subluxation.

• The olecronon of the ulna can subluxate in

all of the above directions, plus posterior.

• The humerus can subluxate lateral, medial or

rotate internally or externally.

• If you ask them to put the point of their finger

on the exact spot where it hurts, it can

sometimes help you to narrow it down.


EPICHONDYITIS

• The two types of epichondylitis are:

• Lateral – Tennis elbow

• Medial – Golfers Elbow!

• Make sure your golfers know about

keeping the lead elbow straight

• Snapping it straight fifty to a ninety times

in a game can irritate and subluxate the

joint.

• Keeping it straight gives more distance

and accuracy.


SOFT TISSUE COMPONENTS

• The humerus can subluxate lateral, medial or rotate

interiorly or externally.

• There can be soft tissue components to epichondylitis

that, for all intents and purposes should be treated as

subluxations BECAUSE THEY ARE DIRECTION

SENSITIVE!

• Stroke anterior and posterior just superior to the

lateral epicondyle and the medial one to check for a

leg length change. Correct directionally in the soft

tissue in the direction opposite of what caused the leg

length change.

• Not into using an instrument? Do transverse massage

across the soft tissue structures.


LASER THERAPY

• If you have an Erchonia 5000, program it

for either pain and inflammation

(arthritis), trauma, ligament stability or

muscle spasm. Apply the programmable

head to the joint or the affected

epicondyle and the pre programmed to

C6 for 180 seconds. Ideally, have the

patient move the elbow during therapy.

• If you have another laser, program it for

inflammation and apply according to your

protocols while the joint is in motion.

• Laser therapy, when used with every

adjustment, measurably accelerates

healing and stabilizes the healing sooner.


THE WRIST

• Low backs, knees and elbows are more

common to amateur golfers and high

handicappers.

• Wrist injuries in golfers is more common

in low handicappers and pros.

• This is due to hitting out of sand and

deep rough.

• Carpal tunnel syndrome is only one of

many kinds of wrist pain.

• We’ll look at several wrist and hand

problems.


GRIP STRENGTH AND BALL CONTROL

• A strong grip counteracts a slice

• A weak grip counteracts a hook.

• With a strong grip the lead hand is placed

more toward the upper side of the club

shaft.

• With a weak grip the hand is rotated

toward the side of the club shaft.

• A closed stance helps counteract a slice

• An open stance tends to counteract a

hook.

• Is this a strong grip or a weak one?


CARPAL TUNNEL

• (a strong grip)

• The carpal tunnel is composed of the

eight wrist bones (carpals) and the

retinaculum. Change their alignment

shape and they compromise the size of

the tunnel.

• The ulnar tunnel is more sensitive to the

position of the pisiform bone on the hand.

• The first thing to identify in wrist problems

is the distribution of the complaint. Is it

medial nerve? Ulnar nerve? The entire

hand? Is it the distal forearm, the wrist or

the hand?

Median Nerve

Carpal Tunnel

Ulnar nerve

Ulnar Tunnel


DIFFERENTIATING

• Have the patient make a fist and check the leg lengths. A change indicates a lateral distal radius. Correct medially.

• Press the ulna posteriorly and check leg lengths. A positive indicates a posterior distal ulna. Correct palmar.

• Have the patient bend the hand at the wrist, palmar. A positive indicates a posterior distal row of carpal bones. Correct all 4 palmar.

• Have the patient bend the hand at the wrist dorsally. A positive shows an anterior proximal row of carpals. Correct posteriorly.

• Have the patient touch the little finger to the thumb and squeeze. A positive indicates an anterior lunate – a BINGO for a true carpal tunnel syndrome.


“THUMB” COMPLAINTS

• Complaints about the thumb must always

be narrowed down as well. Most are at

the base of the thumb.

• You can palpate or do leg checks for all

of the joints of the thumb itself and adjust

accordingly.

• Also check for a posterior trapezoid by

pressing it dorsally through the palm and

checking the leg length. The line of drive

for correction is anterior and slightly

medial.

• This is a great one for when they say,

“I’ve got arthritis in my thumb right here.”


LASER THERAPY

• If you have an Erchonia 5000, program it for either nerve entrapment syndromes, pain and inflammation (arthritis), trauma or ligament stability. Apply the programmable head to the joint or the affected area of the wrist and the pre programmed to C6 and the brachial plexus for 180 seconds. Ideally, have the patient move the wrist during therapy.

• If you have another laser, program it for inflammation and apply according to your protocols while the joint is in motion.

• Laser therapy, when used with every adjustment, measurably accelerates healing and stabilizes the healing sooner.


THE SHOULDER

• The majority of shoulder injuries in

golfers result from using the arms too

much in the swing rather using the entire

body.

• The golfer should actually rotate around

the spine rather than excessively

swinging the arms.

• Since the shoulder joint is such a sloppy

joint, it can result in a myriad of

subluxations that can be difficult for many

chiropractors and orthopedic doctors to

identify correctly.

• Correct identification is crucial to the

proper correction.


SHOULDERS: GLENO-HUMERAL

• Comprised of the ball of the humerus and the

glenoid fossa of the scapula. Even though it’s

considered a “ball and socket” joint, its more of

just a round thing in a hollow spot.

• The humerus can subluxate anterior, posterior,

superior or inferior and it can rotate internally or

externally.

• Isolating the exact subluxation is vital in order to

make a true correction.

• When you’ve identified the line of subluxation, the

line of correction will be in the opposite direction.

• The contact point should be as close to the joint

space as possible to facilitate fascial

communication.


SHOULDERS: CORACOID PROCESS

• Often associated with accompanying TOS,

hand parasthesias, carpal tunnel symptoms

with or without carpal subluxations. Symptoms

will be medial to the GH joint. Often the

scapula will be lifted in the back.

• The coracoid process tends to rotate inferiorly

and anteriorly, but check it. Our bodies don’t

read the books.

• Contact the tip of the coracoid process and

correct in a line of drive opposite to the

direction identified as the subluxation.

• Then look for other scapular subluxations and

rotator cuff components.


SHOULDERS: THE AC JOINT

• Where the acromion process and the clavicle

articulate. “The point of my shoulder.”

• Have patients press the hand into their side

and check the leg length. A positive indicates

a separated shoulder.

• Adjust medially on the acromion process and

laterally on the clavicle.

• The clavicle can also subluxate superior, or

anterior.

• Theoretically, it can also go inferior or

posterior, but I’ve never seen these.

• Correct opposite the direction of subluxation.


SHOULDERS: THE SCAPULA

• With the patient prone the doctor can stroke

superior, inferior lateral or medial on the

scapula and look for a leg length change.

Correct in the direction opposite the

subluxation.

• Contact point for a medial scapula would be

three points on the medial border.

• Contact points for a lateral scapula are three

points on the lateral border.

• For a superior scapula contact three points on

the superior aspect of the scapular spine.

• For an inferior scapula contact three points on

the inferior aspect of the scapular spine.


SHOULDERS: THE BICEPS TENDON

• The biceps tendon must “ride” in the biceps

groove at the head of the humerus.

• Symptoms are on the front of the shoulder

inferior to the GH joint, sometimes down into

the biceps area itself.

• The biceps tendon can “subluxate” laterally

or medially.

• Correct at three points on the tendon itself

and thrust in a line of drive opposite the

subluxation.


SHOULDERS: THE ROTATOR CUFF

• The supraspinatus Lateral

• Infraspinatus Inferior

• Teres minor Medial/Superior

• Subscapularis Unreachable

• Check for a rotator cuff by abducting the hand, thumb down. Look for a leg length change.

• Standing, look for pain with abduction or with slight downward pressure against resistance.

• Laser with muscle and/or tendon protocols and support the associated cervicals.


SHOULDER: OTHER

• “Shoulder” can mean a great many things that aren’t really the shoulder joint at all. Be sure to narrow it down.

• First, second or third rib, front or back.

• Superior manubrium can affect all three upper ribs.

• Shoulder complex – scalene muscles, anterior first rib body, levator scapulae, and the splenius capitus.


LASER

• Use a laser to accelerate resolution. With an

Erchonia, set it on inflammation and pain,

ligaments, scarring, nerve entrapment

syndromes or trauma settings.

• Set the pre-programmed head on the cervical

spine and the programmable one on the

area(s) of complaint for 180 seconds.

• Get the best results when motion accompanies

the laser treatment.

• If you have a different laser, be sure you are

isolating the exact spot, with the appropriate

setting depending on whether it’s traumatic or

chronic, ligamentous, articular or muscular and

treat with accompanying motion.


HIPS • So you’ll know what joint(s) to

check, say, “Show me where!”

• Some point to the SI

• Some point to the Iliac crest

• Some point to the greater

trochanter

• Some point to the groin.

• Some will even point to their

bottom.


HIPS

• As chiropractors, you’re great

at adjusting SI’s and the pelvic

girdle.

• What we want to go over here

today is the acetabular

articulation and the greater

trochanter.

• I’ll also give you a neat little

tip about the cluneal nerve.


HIPS

• The trochanter can rotate

internally or externally.

• It can also subluxate superior or

inferior which are less common.

• These are probably the most

common cause of trochanteric

bursitis.

• Correct in the direction opposite of

the subluxation.Support the correction with laser on the

trochanter and the lumbo-thoracic area

of the spine.


HIPS

• At the acetabular joint the ball of the femur most commonly subluxates anteriorly or posteriorly.

• Pressure test to identify the subluxation.

• This is the major cause of groin pain!

• It can also cause deep buttock pain in the mid-buttock area.


HIPS

• Commit this picture to memory!

• Find the acetabular joint in front at the groin, just medial to the superior aspect of the greater trochanter.

• Find it in the back at mid-buttock medial to the superior aspect of the greater trochanter.

• Correct in the direction opposite the subluxation.

Support the adjustment with laser therapy

on an inflammation or ligament setting and

on the lumbar region of the spine.


THE CLUNEAL NERVE

• The cluneal nerve must travel through an

osseofibrous tunnel at the iliac crest.

• It often binds in that tunnel causing

buttock pin in the upper to mid buttock.

• DO NOT CONFUSE THIS WITH SCIATIC

PAIN!!!

• Sciatic pain is in the LOWER buttock more

medial.

• Check for directional components by

stroking laterally and medially across the

nerve.

• Correct with an instrument at three or

more points along the nerve.


THE CLUNEAL NERVE

• You can also do deep tissue transverse

massage at several points along the nerve.

• When upper buttock pain is accompanied

by lateral lower leg pain to the ankle, also

check for a fibular subluxation at the knee.

• This combination of symptoms is almost

always MIS diagnosed as sciatica!

• With a laser, treat for nerve entrapment

syndromes, and along the lumbar spine.

Transverse massage simultaneously.

• I cannot overemphasize the importance of

knowing about this and using it daily in

your practice!


LASER EQUIPMENT

• The literature on low level laser therapy is accumulating every day, showing its incredible benefits for healing.

• I believe the best two on the market are the Teraquant, a single dot laser with magnets and infra red. It seeks an exact spot then treats the spot. It can be programmed for several different benefits.

• The one I like best is the Erchonia 5000. It uses laser lines rather than dots so it covers a tremendous area by comparison and 20 minutes of therapy can be accomplished in about 3.

• It can be programmed for up to 100,000 different benefits.

• If you don’t have one already, be sure to investigate laser therapy for your practice.


THE FOOT AND ANKLE

• The foot and ankle are like the foundation of a building. If it’s off, the entire building (skeleton) will suffer.

• Because there are so many bones in the foot and ankle be sure to isolate the problem by having them put the point of a finger on the exact spot that hurts.

• Eversion sprains can create ankle pain for instance, but it’s very different than anterior talus subluxations.

• Lets go over the most common subluxations in the foot and ankle, realizing that every bone can subluxation in a variety of directions.


THE FOOT AND ANKLE

• Check for a calcaneus subluxation. It can rotate medially or laterally, or the posterior aspect can drop or go superior. It can also subluxate anterior or posterior.

• Leg length tests can identify the subluxation. Correct opposite the direction of subluxation.

• After eversion sprains always check for subluxations in the fibula at both the ankle and the knee and correct appropriately. Most common with eversions is inferior fibulae due to the direction of injury.

• With inversion sprains look for subluxations in the opposite direction.


THE FOOT AND ANKLE

• Pain in the superior part of the foot at the

ankle you might find an anterior talus.

Plantar flex the foot at the ankle and check

leg lengths. Correct posterior when you find

a positive.

• The navicular can be subluxated when

there’s pain on the top of the foot. Squeeze

and pull superior to identify. Correct inferior.

• Subluxations at the head of the fifth

metatarsal can be very painful. Check

superior and inferior and correct in the

direction opposite to subluxation.

• These corrections will give you lots of tools

in your bag, however …


THE FOOT AND ANKLE

• What will help you give more relief than any other adjustment is a dropped cuboid.

• Just posterior to the head of the fifth metatarsal, it serves like a keystone to the arch.

• When it drops the arch drops and causes bunions over time,

• Plantar fasciitis in the short run

• And heel spurs in the meantime.

• Heel spurs DO NOT cause the pain!

• What’s causing the heel spurs also causes the pain. The pain can be eliminated long before the heel spur is reabsorbed.


PLANTAR FASCIITIS

• For plantar fasciitis, correct the cuboid, look for a dropped 1st met – cuneiform, a superior calcaneus and tape the foot to externally support the spring ligament between adjustments.

• Place a piece of anchor tape on the ball of the foot.

• Tape from the anchor, back the foot & up the back of the heel.

• Tape from the lateral ball of the foot, around the heel to the medial ball.

• Reverse.

• Anchor the tape job.


Wear for 2 to 3 days, remove for two

days and repeat

CONTINUOUS SUPPORT

• Of course, the best approach, in addition to

temporary taping, is continuous precision

support 24/7/365.

• You can do that with Foot Levelers. They’re

precision-made, individualized support made

for the individual from either a computerized

measurement or from casted imprints.

• Adjustments hold better and longer, both in

the lower extremity, from the foot to

acetabulum, to the spinal column itself.

• If you’re not set up for Foot Levelers yet, do

yourself and your patients a favor and get that

started today.


ADJUSTING EQUIPMENT

• The most precise extremity adjusting you

can do is with an adjusting instrument.

• Activators are less expensive and more

mobile since they’re cordless. I personally

prefer the Activator V over all the other

Activators.

• The Impulse instrument has been shown in

studies to also be effective at delivering an

adjustment at six pulses per second. The

best Impulse instrument is the IQ.

• Activators are available from Activator

Methods at www.activator.com.

• Impulse Instruments are available at

www.goimpulse.com.


http://www.activator.com/

http://www.goimpulse.com/

THANK YOU FOR WATCHING!

• Although this presentation was designed for chiropractors regarding extremities for

golfers, it applies to extremities for anyone.

• Look for Dr. Boatright’s books on Amazon.com

• Dr. Boatright is also a health copywriter. Check out his writing website at

www.readem.net

• To find out more about Dr. Boatright’s practices in Phoenix or Show Low, AZ, go to

www.drrickboatright.com. Or www.desertrosechiropractic.weebly.com.

• To see more of Dr. Boatright’s informational literature go to:

www.clunealnerve.weebly.con

www.ralbypublishing.weebly.com

www.easychairworkout.weebly.com




http://www.readem.net/

http://www.drrickboatright.com/

http://www.desertrosechiropractic.weebly.com/

http://www.clunealnerve.weebly.con/

http://www.ralbypublishing.weebly.com/

http://www.easychairworkout.weebly.com/

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