Could Manual Therapy Provide Relief for Leg, Knee, Ankle or Foot?

What are lower extremity disorders and how are they treated?

When pain or discomfort is more prolonged, painkillers alone may not be enough.

It could point to an underlying chronic condition of the veins and arteries, where blood flow is restricted. These conditions can be especially serious as they may impact the heart and other organs.

Treatments range from wearing stockings that direct the flow of blood to taking diuretic medicine that reduces swelling, painkillers to ease the discomfort, and anticoagulants that prevent blood from thickening.

Commonly, pain in the lower extremities is due to osteoarthritis. This can affect all joints, including hips, knees, and ankles and may gradually worsen with age.

Lower extremity osteoarthritic pain is usually managed with pain medication and, in more serious cases, surgery is often recommended.

Extremity relief with manual therapy?

Most people are aware of the capabilities of manual therapy to ease back and neck pain.

Many also advocate manual therapy for problems in other areas of the body resulting from “referred” pain from spinal problems.

But while doctors specialising in manual therapy are seen as “spine specialists”, the benefits of manipulative therapies are increasingly being considered for a wide range of less obviously connected disorders: from migraines to heart conditions and sleeping disorders to bladder problems.

We can include problems with the lower extremities in this.

There is evidence for the application of manual techniques for the management of conditions of the lower extremities dating back to the early 20th century and the founding of modern-day chiropractic care.

Several recent studies have been conducted into the use of manual therapy in treating lower extremity disorders.

In one review of the literature published in the Journal of Manipulative & Physiological Therapeutics in 2006, the authors set out to document the quantity and type of peer-reviewed research conducted on the chiropractic management of lower extremity conditions.

They found 76 relevant studies with 24 related to the foot, 10 to the ankle, 25 to the knee, and 17 to the hip. Ten of these studies were clinical trials.

The authors concluded that “the basic overarching model of similarity of indications for and beneficial effect/responsiveness of patients to manipulative therapies for joint conditions throughout the human body merits further attention.”

A later study conducted a systematic review on manipulative therapy for lower extremity conditions, expanding on the above study by reviewing research published between 2006 and 2008.

A total of 39 relevant citations were found, yielding “fair evidence for manipulative therapy of the knee and/or full kinetic chain and of the ankle and/or foot, combined with multimodal or exercise therapy for knee osteoarthritis, patellofemoral pain syndrome, and ankle inversion sprain.”

The conclusion was that “there are a growing number of peer-reviewed studies of manipulative therapy for lower extremity disorders.”

Your “spine doctor” may be able to help with problems lower down…

There is a “spine only” focus by some chiropractic professionals and their patients but evidence suggests that this is a limiting outlook.

Peripheral conditions make up one-sixth of chiropractic chief complaints. They are the third most reported location for complaints after low back/pelvis and neck pain.

This, together with the growing evidence that manual therapy has a beneficial effect on many common problems with lower extremity joints, suggests that there may be a viable alternative to a lifetime of pain medication and surgery.

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References

Wayne Hoskins et al. Chiropractic treatment of lower extremity conditions. J Manipulative Physiol Ther 2006;29:658-671

James W. Brantingham et al. Manipulative therapy for lower extremity conditions: expansion of literature review. J Manipulative Physiol Ther 2009;32:53-71.

Brantingham JW, Snyder WR. Old Dad Chiro and extravertebral manipulation. Chiropr Hist 1992;12:8-9.

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