‘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…