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Dr Tom Scott is an  experienced Chiropractor from Prestatyn, Wales.  He uses laser extensively as  an adjunct to his main practice.


Tom is passionate about the use of LLLT and has developed several techniques to improve its effectiveness on patients with debilitating pain conditions.


He is keen to share these experiences and techniques with other laser practitioners and is hoping to offer workshops at his clinic in North Wales.


For more information on Tom’s practice contact him via www.prestatynchiro.co.uk


Tom Scott

Correction of chronic joint conditions using Applied Kinesiology (AK) and LLLT

Correction of Chronic Knee problems


PDF Downloads

Part 1


Part 2


Reflex Points Appendices

Test: Patient prone with 60° knee flexion, examiner directs pressure against the lower leg just superior to the ankle, take care not to contact the ankle itself. This tests the hamstrings as a group; to test the medial and lateral hamstrings separately contact the lower leg medially for medial hamstrings and laterally for lateral hamstrings. Pressure is directed slightly medial to lateral and lateral to medial respectively.

Neurolymphatic: Anterior- Over lesser trochanter of the femur.

Posterior- Upper sacroiliac articulation by the posterior superior iliac spine.

Neurovascular: 1 inch above lambda on skull.

Sartorius

Action: Flexes knee and hip, rotates the thigh externally. When knee is flexed rotates tibia internally. Gives medial support to knee.

Posture: Weak sartorius and/or gracilis can lead to genu valgus (Knock knees) – also affects anterior – posterior balance of pelvis.

Test: Patient supine flexes the hip and knee with abduction of the hip. Examiner directs pressure against the anterolateral leg just above the knee, in a direction that extends the knee with medial pressure and internal rotation of thigh. With the other hand gripping the lower leg above the ankle medially and at same time extends the leg.

Neurolymphatic: Anterior- 2 inches above the umbilicus and 1 inch from the midline.

Posterior- T11, T12 bilaterally near laminae.

Neurovascular: Lambda

Gracilis

Action: Adducts thigh, flexes knee and hip, and internally rotates the thigh and tibia.

Posture: As for sartorius

Test: Patient prone the knee is flexed to approx 45° and the thigh internally rotated. Examiner elevates the knee from the table by hip extension and supports patients thigh on examiners thigh (this helps to reduce the action of the hamstrings from the test). Pressure with the other hand is directed against the medial lower leg above the ankle in the direction of knee extension and slightly laterally to induce slight medial thigh rotation.

Neurolymphatic, Neurovascular same as Sartorius above.

Popliteus

A bilateral weakness may indicate a lower cervical fixation and recommendation to a Chiropractor /Osteopath would help long term correction.

Due to its action it is often associated with clicking/locking knees.

Action: Rotates the tibia internally on the femur or the femur externally in the tibia, depending on the one that is fixed; withdraws the meniscus during flexion, and provides rotatory stability to the femur on the tibia; brings the knee out of “screw home” position of full extension; helps with posterior stability of the knee.

Posture: Allows knee hyperextension

Test: With patient prone and knee flexed 90°, pressure is directed on the distal medial foot, with counter-pressure on the calcanius to produce lateral rotation of the tibia on the femur. The actual testing motion is slight and can be evaluated only by observing the tibia rotating on the femur and watching for motion of the tibial tuberosity. It is quite possible for the examiner to obtain foot rotation, appearing to be a weak Poplitius; in fact, it may be a twisting of the tibia and fibula.

Neurolymphatic: Anterior- 5th intercostals space from mid-mamillary line to sternum on the right.

Posterior- Between T5-6 laminae on right.

Neurovascular: Medial aspect of knee at meniscus.

Tensor Facia Lata (TFL)

Action: Thigh flexion, abduction, and internal rotation. TFL along with gluteus maximus, pulling on the iliotibial band helps stabilise the knee laterally.

Postural: Genu varus and pelvic elevation on weak side. Works in conjunction with Gluteus maximus.

Test: Patient supine with the leg in a position of abduction, slight internal rotation, elevated approx 30°, with the knee straight and locked. Testing pressure is directed against the lower leg medially and inferiorly. Note the knee most remain locked in hyperextension during the test.

Neurolymphatic: Anterior- anterolateral thigh bilaterally.

Posterior- triangular area with apexes at L2, L4 and the crest of the Ilium.

Neurovascular: Parietal eminence at the posterior aspect

Gastrocnemius

Action: Plantar flexes the foot

Postural: hyperextension of knee

Test: This test must be correlated with the hamstrings as they are significantly synergistic in this test. For both medial and lateral heads of the Gastrocnemius the patient lies supine with knee flexed at approx 110° and with maximum plantar flexion of foot examiner stabilises the knee while extending it by pulling on the heel. Medial head can be tested with internal rotation and the lateral head with external rotation.

Neurolymphatic: Anterior- 2 inches above umbilicus and 1inch from midline

Posterior- between T11, T12 bilaterally near laminae.

Neurovascular: Lambda

These are muscles that act over the knee joint directly the next group of muscles have a direct influence on the knee.

Adductors

Action: Adduction of the femur, some connections of the adductors also assist in hip flexion.

Postural: Genu Varus on weak side. Pelvic elevation on opposite side.

Test: patient supine with both legs together and lateral to the midline. Examiner contact is inferior to knees and attempts to separate legs by pulling medial leg toward midline. The medial leg is the side of adductor muscle test.

Neurolymphatic: Anterior- behind the areola, not in the breast tissue. If the patient is female have her lift her breast out of the way. Be careful to inform the patient of your intent and get their consent before proceeding. If there is any concern having another female present like a staff member can diffuse any fear of impropriety.

Posterior- Below inferior angle of scapula.

Neurovascular: On lambdoidal suture between Lambda and asterion.

Gluteus Maximus

Action: Extends hip, assists in externally rotating the thigh.

Postural: Provide3s posterior pelvic, lateral knee support. Weakness leads to lumbar lordosis, facet syndrome and knee instability.

Test: patient is supine with knee flexed 90° and elevated. Examiner applies pressure inferiorly on the lower 1/3 of femur. Examiner must not allow patient to straighten the knee (an attempt to recruit the hamstrings on a weak muscle.) or to allow thigh abduction during test.

Neurolymphatic: Anterior- Anterolateral thigh (TFL)

Posterior- Between posterior superior iliac spine and L5 spinous.

Neurovascular: On lambdoidal suture between Lambda and asterion.

Gluteus medius/minimus

Action: Abducts thigh and rotates it internally. Works in conjunction with gluteus minimus

Postural: lateral stability of pelvis. Weakness leads to elevation of hip, shoulder, head on side of weakness.

Test: patient is supine with leg straight abducted and slightly elevated. Examiner applies a slightly inferior pressure in direction of adduction. Contact is on lower leg for leverage. Direction of testing pressure is lateral to medial.

Neurolymphatic: Anterior- Upper symphysis pubis.

Posterior- Between posterior superior iliac spine and L5 spinous.

Neurovascular: Parietal eminence at the posterior aspect.

Psoas

Action: Flexes and gives minimal action in external rotation and abduction of the thigh.

Postural: Toe in of foot with a tendency to pronation on side of weakness. Elevates pelvis with lumbar deviation away from weakness.

Test: The supine patient flexes, abducts, and externally rotates a straight leg, examiner contacts inferior to the knee and directs pressure down and out while stabilising the anterior part of the pelvis on the opposite side. Move your contact hand closer to the ankle on stronger patients.

Neurolymphatic: Anterior- 1 inch above umbilicus and 1 inch from the midline.

Posterior- T12-L1 between spinous and transverse processes.

Neurovascular: 1 ½ inches lateral to external occipital protuberance.

LILT procedures

This may differ from other practitioners, and is not presented as the difinative guide but only to represent my current understanding of the application of LILT. So, please, if you have any variations or improvements or would like to present a variation on the procedure please contact me.

With patient prone I apply the 60x probe to popliteal fossa in two sessions first slightly superior and the other inferior. This is to maximise lymphatic drainage Dose is set to 1 min or 6 J/cm² each. I like to use the multipulse function and set to 20/10/2.5Hz. On some chronic arthritic knees there is also lymph build up in the anterior bursa, if this is the case them I apply LILT as above to both medial and lateral compartments – for clinic evaluation and record keeping I use a cloth tailors tape to measure the initial diameter of a swollen knee to determine effectiveness of treatment protocols. Then using the 5 x 820nm by 200mW Cluster Probe, I work along the medial and lateral meniscus as well as the inferior and superior patella tendons. Often there is involvement with the fibula head with can often get misplaced posteriorly this can be confirmed by tenderness around the fibula head. This will usually also lead to tenderness in the lateral malleolus as this develops a torque along the fibula. LILT should also be applied to this area. Dose per point is 15 sec or 24 J/cm². If patient describes pain down into their shin this is often the cause. Look for trigger points along the anterior –lateral shin these can be treated with the 820nm by 200mW Single Probe at a dose of 25 sec or 24J/cm² and a frequency of 145Hz.

If you found this interesting or helpful or have anything to add or discuss please feel free to contact me Dr T Scott D.C. Prestatyn Chiropractic Centre, 88 high St, Prestatyn, LL19 9BE. Or email to tom@prestatynchiro.co.uk. This article is not all inclusive of the treatment options available to the Laser therapist but was written to offer a general guide to the application of AK and the chiropractic perspective to the treatment of knee injury.

Most of this information is available from the text

APPLIED KINESIOLOGY

Synopsis 2nd edition

David S. Walther

Neurovascular reflexes

In the early 1930s a Chiropractor, Dr Terence Bennett discovered locations about the head that he felt influenced the vascularity of different organs and structures. During the mid 60s Dr Goodheart found that he could improve muscle function, as determined by manual muscle testing, by stimulating the Bennett reflexes. These reflexes became known in AK as neurovascular reflexes (NV). A specific muscle responded to only one reflex, but most reflexes influenced more than one muscle. Bennett’s reflexes are primarily on the anterior surface of the trunk and head.

See separate pages at end of part 2 for diagram of neurovascular points – these pages can be printed off and used a reference in time you will memorise the most common used points.

Stress Receptors

In Applied Kinesiology skin receptors on the skull are known as “stress receptors”. These receptors where traditionally stimulated with linear digital pressure. As with the above receptors I discovered in my practise that they responded to stimulation with laser as well. These reflexes can improve muscles that test weak and, in addition, can reduce activity in hypertonic muscles that tend to cramp or are actually in spasm.

See separate page at end of part 2 for diagram of stress receptor points – these are also able to be printed off for reference. I started with them blue tacked to my wall. There are wall charts available from AK supply websites in the USA but can be a little overwhelming at first.

Temporal Sphenoidal line

The temporal sphenoid line (TS line) was described by M.L.Rees, D.C. of sedan, Kansas. A complete treatment procedure using his methods has been developed into the Chiropractic technique –Sacro-Occipital Technique (SOT) developed by Dr M Dejarnete. Points along the TS line relate with specific organ dysfunction. Goodheart found that the points described in SOT for organ dysfunction correlated with his muscle-organ/gland associations. I mention this here because muscle weakness can be related to specific organic dysfunction ( not covered in this article). Should you find difficulty correcting a weak muscle with the procedures that I will lay out further on then there may be an organ/gland dysfunction involved and testing along the TS line with TL and applying laser input to that location may correct a stubborn problem with often far reaching benefit for the patient beyond your initial expectations –but again I get beyond myself.

Protocols for correcting a muscle weakness

In part 1 on the knee we will concentrate on the protocols as they will apply to other joints in the body. In part 2 we will describe the testing and correction procedures for the knee. There is a recommended order to take in returning muscle strength based on the most common priority. Some practitioners may vary or skip procedures depending on the requirement in your individual clinics, although it is recommended that this order be followed. If you do decide to skip steps, and muscles do not correct, then you will have to back track to steps missed, so I’ll lay this out in order that it was presented to me over the years.


1 Stimulation of the Golgi tendon organ – If a muscle has been over stressed or injured then possible micro avulsions of the muscular tendon can lead to adhesions and nodules developing around these stretch receptors leading to a chronic weakness of the muscle. Traditionally this was corrected by digital (finger) stimulation in the tendon/muscle junction. I have discovered that these receptors respond to laser input. The procedure is to apply laser to the muscle/tendon junction at the origin and insertion of the muscle involved and retest muscle to determine whether the muscle has recovered normal strength. To do this I use an Omega Clinic with a 820nm by 200mW Single Probe for smaller muscles or the 5 x 820nm by 100mW Cluster Probe for lager muscles such as Quadraceps. Dose is 15 sec or 24J set on multipulse of 20/10/2.5. If your system does not have multipulse settings it is recommended that you select a frequency below 100 Hz. This Procedure is referred to as laser activated origin and insertion technique.



2 If this fails to normalise muscle function then apply laser to Neuromuscular spindle by placing the probe in the belly of the muscle, palpation of the muscle belly will usually produce an area of pain and tightness this will help you determine probe placement more accurately.


3 If the muscle still tests weak then move on to the neurolymphatic reflexes or Chapman reflexes. As with the golgi tendon organs I found that when stimulated with laser light they often improved the function of the associated weak muscle. Procedure and dose is the same as with the laser activated origin/insertion technique.



4 If the muscle still tests weak you then move on to the neurovascular reflexes ( some practitioners may prefer to go the neurovascular reflexes before the neurolymphatics as it does not require the inconvenience of removing clothing to get a skin contact over the desired reflex point on the body.). The procedure and dose is the same as with the neurolymphatics.



5 If this still fails to correct the muscle weakness then proceed to the Stress receptors. Because these receptors are often linear I found that the single probe on a high frequency or set to constant beam. I found that 15sec was usually adequate to apply the required stimulation.



6 In most cases these procedures will provide the results that you will be looking for. There are other levels that can be stimulated on stubborn cases but it would take too long to go into them all in this article but if you require further advice I am available via my clinic. See contact details at end of this article.


Muscle testing procedures

These procedures are the standard testing procedures used in Applied Kinesiology. The manual muscle test, as generally, described, begins with the examiner placing the test muscle in the starting position and asking the patient to resist as the examiner applies a force to the patient. The examiner will feel a sensation of the muscle locking. With this perception, the examiner increases the testing pressure while the patient continues to prevent movement. Some practitioners ask the patient to push against the test pressure and the sensation of muscle strength is then evaluated as the examiner allows the patient to slightly over power the test pressure. Like all clinical testing procedures there is a level of skill involved in producing consistently accurate results and these skills will develop with time and practice. When unsure of a positive muscle weakness, test the muscle on the other limb (I do this as routinely anyway – it also allows the patient to be involved in the experience and gives them something to compare to when you retest and weakness has been corrected). Applying the corrective procedures will often show a significant increase in strength of the test muscle and that can confirm your findings. With a muscle weakness the patient may try to move out of the initial test starting position in an attempt to recruit other muscles to perform the test action care must be taken to avoid this situation by instructing the patient to stay in the position you initially set for the test.

Special note in dealing with the muscles of gait as there is an synergistic relationship especially between Quadriceps and hamstrings. Simply as the right quads contracts in walking there is a reactive relaxation of the left hamstrings. A muscle spasm in an athlete’s left hamstrings that do not respond to stretching and massage and other therapies applied to that hamstring, will often be related to a weakness in the right quads.

Correction of the weak quads on the other limb will often resolve this problem and make you look like a miracle worker; by only moving your fixation from treatment of the symptom to an understanding of the mechanisms involved and applying a logical application to the dysfunction; in the area that the dysfunction occurs. Remember that for every action there is an equal and opposite reaction. Try not to get hooked up on reactions in your clinic.

Therapy Localisation

A major development in AK occurred when Goodheart observed that if a patient touched an area of dysfunction, the results of manual muscle testing changed. A muscle that previously tested weak became strong when the patient touched an area of dysfunction. The system is called therapy localisation (TL). It can help find the location of a problem, but does not necessarily tell you what is wrong. It can be used to verify the location of neurolymphatic, neurovascular, and stress receptor points on the body. It also works in reverse where a previously strong muscle will test weak with TL. This is why it is important that the patient does not have their hands on their body but by their sides during a muscle test. It is also why I recommend not contacting over a joint during a test as joint dysfunction may be present giving a positive TL that is mistaken for a weak muscle. When in doubt change the muscle being tested, or change your contact points. This situation has often highlighted problems that I was unaware of at the time of testing, this lead to me backtracking finding the dysfunction, correcting it , then returning to my testing procedure only to find that previously weak muscles had balanced out and no further work was needed. This can lead to a hunt for the culprit involved and will add a new dimension to your practice, but I digress.