TABLE OF CONTENTS

EXORDIUM -22
Development of the Manipulative Arts in North America -22
Historical Perspective -22
Articular Therapy in the 20th Century -23
Clinical Rationale -25
General Indications for Articular Therapy -25
Disuse with Continued Venous Stasis -26
Recurrent Edema -26
Recurrent Trauma from Passive Stretching -27
Prolonged Trauma from Immobilization -28
General Contraindications for Manual Mobilization of Joints -28
Terminology: Manipulation vs Adjustment -29
Manipulation -29
Chiropractic Adjustments -30
References -31

1. Adjustment of Lower Extremity Joint Subluxation-Fixations

Introduction -33
Screening Tests for the Lower Extremity as a Whole -33
Initial Considerations -34
Lower Extremity Postural Balance -34
Leg Length Discrepancies -34
Paralysis -35
Lower Extremity Circulatory Insufficiencies -35
Some Considerations Prior to Adjustive Therapy -38
Hip Subluxations and Fixations -39
Initial Considerations -39
Hip Pain -40
Common Differentiation Clues -41
Hip Fixations -41
Releasing Inferior Distraction Fixations -42
Releasing Flexion Fixations -42
Releasing Extension Fixations -43
Releasing Lateral Hip Fixations -43
Hip Subluxations -44
Internally Subluxated Femur -44
Externally Subluxated Femur -44
Superiorly Subluxated Femur -45
Anteriorly Subluxated Femur -45
Posteriorly Subluxated Femur -45
Sciatic Displacement -46
Chronic Hip Dislocation -46
Posterior Dislocations -46
    Anterior Dislocations -47
Central Dislocations -47
Trendelenburg's Hip Test - 47
Acute Hip Dislocation -47
Roentgenographic Considerations -48
Knee Subluxations and Fixations -49
Initial Considerations -49
Knee Posture -50
Genu Valgum: Physical Signs of Knock-Knee -50
Genu Varum: Physical Signs of Bowed-Leg -51
Mikulicz's Roentgenographic Line -51
Therapeutic Considerations -51
Genu Recurvatum -52
Tibial Rotation and Torsion -52
Knee Fixations -52
Patellofemoral Joint Motion Restrictions -52
Femorotibial Joint Motion Restrictions -53
Proximal Tibiofibular Joint Motion Restrictions -56
Tibial Subluxations -57
Medial Tibia Subluxation -57
Anterior Tibia Subluxation -57
Lateral Tibia Subluxation -58
Posterior Tibia Subluxation -58
Internally Rotated Tibia -58
Externally Rotated Tibia -59
Fibular Subluxations -60
Inferior Fibula Subluxation -60
Superior Fibula Subluxation -60
Anterolateral Fibula Subluxation -61
Posteroinferior Fibula Subluxation -61
Posteromedial Fibula Subluxation -61
Patella Subluxations -62
Superior Patella Subluxation -62
Superomedial and Superolateral Patella Subluxations -62
Inferior Patella Subluxation -62
Patella Dislocations -63
General Considerations -63
Reduction Technic -64
Management Considerations -64
Knee Dislocations -64
Ankle Subluxations and Fixations -65
Initial Considerations -65
Ankle Pain -65
Ankle Fixations -66
The Ankle Mortise -66
The Subtalar Joint -67
Ankle Subluxations -67
Anterior Talus Subluxation -67
Lateral Talus Subluxation -68
Medial-Inferior Talus Subluxation -68
General Characteristics of Ankle Dislocations and Fractures -69
External Rotation Injuries -69
Abduction Injuries -69
Adduction Injuries -70
Foot and Toe Subluxations and Fixations -70
Initial Considerations -70
Foot Fixations -71
Midfoot Fixations -72
Forefoot Fixations -72
Foot Subluxations -73
Anterior Calcaneus Subluxation -73
Posterior Calcaneus Subluxation -73
Inferomedial Navicular Subluxation -74
Lateral Cuboid Subluxation -74
Inferior Cuboid Subluxation -75
Inferior Tarsal or Proximal Metatarsal Subluxation -75
Superior Tarsal or Proximal Metatarsal Subluxation -76
Inferior Distal Metatarsal Subluxation -76
Common Toe Subluxations and Deformities -77
Hallux Valgus -77
Bunion -77
Claw Toes -77
Hammer Toe -78
Mallet Toe -78

2. ASSOCIATED STRAINS, SPRAINS, AND CONTRACTURES OF THE LOWER EXTREMITY

Introduction -84
Initial Considerations -84
Aids in Ruling Out Fractures and Gross Pathology -84
Leg Length Discrepancy Effects -87
Hip Sprains and Strains -88
Hip Motion -88
Posttraumatic Hip Spasm -90
Adaptation to Hip Abductor Weakness -91
Direction of Muscle Therapy in Postural Hip Distortions -91
Iliopsoas Dysfunction -91
Iliopsoas Hypertonicity and Spasm -92
Iliopsoas Bursitis -93
Iliopsoas Abscess -94
Neoplasms of the Hip and Thigh -94
Piriformis Dysfunction -94
Hip Sprain -95
Entrapment Syndromes of the Pelvis -96
Sciatic Nerve Compression -96
Obturator Nerve Compression -97
Femoral Cutaneous Nerve Compression -97
Possibly Associated Disorders -98
Hip Pointer -99
Trigger Points of the Hip and Thigh --99
Osteoarthritis of the Hip -99
Pelvic Bursitis -100
Causalgia Syndrome -101
Perthe's Disease -101
Gluteal Dysfunction and Related Disorders -101
Gluteal Contusions -102
Gluteal Strains -102
Differentiation -102
Muscle Dysfunctions in the Thigh -103
Groin Strains -103
Sartorius Strain and Tears -103
Adductor Strains -103
Iliotibial Dysfunction -104
The Iliotibial-Band Syndrome -105
Iliotibial Band Contracture -108
Snapping Hip -108
Hamstring Dysfunction -109
Hamstring Spasm -109
Hamstring Strains -110
Hamstring Ruptures -111
Hamstring Contracture -111
Quadriceps Dysfunction -111
Quadriceps Contusions -111
Quadriceps Strains -112
Quadriceps Contractures -113
Myositis Ossificans -113
Knee Sprains -114
Joint Motion -114
Common Clinical Tests -115
Knee Stability -117
Lateral Stability -117
Anterolateral Rotary Instability -117
Anterior-Posterior Instability -118
Posterolateral Rotary Instability -120
Capsule Sprains -120
Collateral Ligament Sprains -121
Medial (Tibial) Collateral Ligament Sprain -122
Lateral (Fibula) Collateral Ligament Sprain -122
Management Considerations -122
Pellegrini Stieda -123
Coronary Ligament Sprains -123
Menisci Injury -124
Menisci Malpositions -124
Menisci Fractures -124
Common Clinical Tests -125
Internal Semilunar Cartilage Injury -126
Triad of O'Donahue -127
External Semilunar Cartilage Injury -127
Cruciate Ligament Sprains -128
Possibly Related Disorders and Deformities -130
Contusions and Bone Bruises -130
Traumatic Synovitis -130
Traumatic Arthritis -131
Popliteal Aneurysm -131
Osgood-Schlatter Disease -131
Osteochondromatosis -132
Osteochondritis Dissecans -132
Peripheral Nerve Injury -133
Patella Dysfunction -134
Patella Tendon Strain -135
Infrapatellar Fat Pad Hypertrophy -136
Intracapsular Pinches -136
Acute Bursitis -137
Chronic Effusion -137
Chondromalacia Patellae -138
Sinding-Larsen-Johannson Disease -140
Bipartite Patella -140
Leg Strains -140
General Management Considerations -140
Need for Muscle Rehabilitation -141
Muscle Fatigue -141
Shin Splints (Tibialis Anterior or Posterior Tendinitis) -142
Gastrocnemius Strain -143
Soleus Strain -144
Popliteus Strain -145
Popliteus Tendon Rupture -145
Plantaris Strains -145
Plantaris Rupture -145
Possibly Related Disorders -146
Gastrocnemius Contusions -146
Fascial Tears -146
Compartment Syndrome -146
Associated Periostitis -147
Associated Traumatic Phlebitis -148
Nerve Contusions -148
Lower Leg Fatigue (Stress) Fractures -148
Arterial Insufficiency -149
Ankle Sprains, Strains, and Contractures -150
Ankle Joint Motion -151
Kinesiology of the Ankle and Foot -152
Achilles Tendon Strains -153
Ruptures -154
Common Clinical Tests -154
Tendinitis -155
Peritendinitis -155
Tenosynovitis -156
Focal Stress Degeneration -156
Dry Sheath -156
Peronei Dysfunction -157
Peronei Spasm and Inflammation -157
Duchenne's Test for Peroneal Paralysis -158
Posterior Tibial Tendon Strain -158
Ankle Instability -158
Clinical Tests -158
In-Toeing --159
Out-Toeing -160
Ankle Sprains -160
Inversion Sprains -161
Eversion Sprains -161
Management Considerations -162
Possibly Related Disorders -163
Effects of Chronic Ankle Pronation -163
Ankle Trigger Points -165
Posttraumatic Ankle Spurs -166
Tarsal Tunnel Syndrome -166
Subtalar Arthritis -167
    Kohler's Disease -167
Talar Osteochondritis Dissecans -168
Cysts -168
Foot Sprains and Strains -168
Loading Considerations in the Foot -169
Postural Realignment -169
Plantar Strains -169
Foot Sprains -170
Rearfoot Sprain -170
Forefoot Sprain -171
Possibly Related Disorders -171
Flat Foot (Pes Planus): General Considerations -171
Flexible Flatfoot -173
Rigid Flatfoot -173
Compensatory Flatfoot -173
Metatarsalgia -174
Freiberg's Disease -175
Neuroma -175
Anterior Compartment Syndrome -176
Posttraumatic Heel Spurs -176
Calcaneal Apophysitis (Sever's Disease) -176
Heel Bursitis -177
Black Heel -177
Fatigue Fractures of the Foot -178
Plantar Fascitis -179
Sesamoiditis -179

3. SUPPORTIVE AND REHABILITATIVE PROCEDURES

Introduction -187
The Healing Injury -188
The Stages of Healing -189
Managing the Healing Process -189
Basic Rehabilitative Considerations -190
Managing the Discomfort Factor -191
General Phases of Therapy -192
Response to Therapy -192
Immobilization Procedures -193
General Indications and Contraindications -193
Mobilization After Support -194
Orthotics --194
Foot Orthotics -195
Biomechanical Factors in Cane Use -195
Pressure Supports -195
The Aircast/Airstirrup System -196
Hydropulse and Pression Units -196
Adhesive Strapping -196
Application Considerations -197
Precautions During Application -197
Bandaging -197
Muscle Rehabilitation -197
Determining the Anatomical Movers of Human Movement -198
Acute and Chronic Spasticity -198
Management Considerations -199
Differentiation -199
Overall Physical Fitness -199
Strength -200
Classifications of Strength -200
Strength Development -201
Pros and Cons of Muscle Training via Exercise Equipment -202
Home Exercise Prescriptions -203
Stretching Devices -203
Electrodiagnosis -203
Nerve Conduction Analyses -204
Degeneration Reactions -205
Miscellaneous Electrical Muscle Testing Procedures -206

4. THE EVALUATION OF JOINT-RELATED DISEASE

Introduction -210
Case Management -210
Acute vs Chronic Disorders -211
Treatment Direction -212
Disorders of Growing Bone -213
Epiphyses -214
Joint Deformity -214
Epiphyseal Disorders -215
Epiphyseal Displacements -215
Osteochondritis -215
Disorders of Bone Calcification -215
Bone Atrophy -216
Decalcification -217
Osteoporosis -218
Osteoporosis vs Disuse Atrophy -219
Sudeck's Atrophy -219
Subperiosteal Calcification -220
The Peripheral Arthritides-220
Synovitic vs Mechanical Lesions -221
Synovitic Lesions -221
Mechanical Lesions -221
Possibly Associated Nonarticular Rheumatism Involving Joints -221
Fibrositis -222
Polymyalgia Rheumatica -222
Causalgia (Reflex Sympathetic Dystrophy) -222
Palmar Fascitis -223
Psychogenic Rheumatism-223
Classification by Location -223
Monarthritis vs Polyarthritis -223
Oligoarthritis -224
Traumatic Arthritis -224
Bone Bruises -225
Periostitis -225
Inflammatory Processes -226
Osteochondritis Dissecans -226
Joint Infection -227
Active Infection -227
Osteomyelitis -227
Special Considerations -229
Bone Destruction and Infiltration -230
Infectious Subperiosteal Calcification -231
Soft-Tissue Reactions -232
Septic Arthritis -233
Acute Pyogenic Arthritis -233
Gonorrheal Arthritis -234
Meningococcal Arthritis -234
Pneumococcal Arthritis -234
Degenerative Joint and Bone Disease -234
Osteoarthritis -236
Atypical Osteoarthritis -238
Ochronosis -238
Hemophilic Arthritis -239
Gouty Arthritis -239
Pseudogout -242
Rheumatoid Arthritis -242
Clinical Features -243
Monoarticular Form -244
Polyarticular Form -244
Management Direction -245
Palindromic Rheumatism -246
Hypertrophic Pulmonary Osteoarthropathy -246
Psoriatic Arthritis -247
Reiter's Syndrome -247
Systemic Lupus Erythematosus -247
Malignant and Benign Tumors -248
Benign Tumors -248
Malignant Tumors -249
Peripheral Nerve Disorders -249
Vulnerability to Trauma -250
Peripheral Neuropathy -251
Neuroarthropathy -252
Contributing Nutrition-Related Disorders -252
Basic Factors Leading to Malnutrition -253
Physical Conditioning Factors Contributing to Malnutrition -253
Stages of Malnutrition -253
Vitamin Deficiencies -254
Vitamin D -254
Vitamin A -254
Vitamin E -255
Vitamin C -255
Thiamin -255
Riboflavin -256
Mineral Requirements -256
Calcium -256
Iron -257
Potassium -257
Sodium -258
Magnesium -258
Zinc -258
Phosphorus -259
Iodine -259