Instrument adjusting, manual adjusting, and mobilization can work together for a lasting effect
Instrument adjusting, manual adjusting, and mobilization can work together for a lasting effectOften, the most effective treatment plans use several modalities. For instance, adjustments may be more effective when combined with mobilization. One injury that may benefit from a multimodal approach is a meniscus tear.
How to get a meniscus tear
There are two menisci—the medial and the lateral. Cedar-Sinai, a non-profit hospital in Los Angeles, defines menisci as “crescent-shaped bands of thick, rubbery cartilage attached to the shinbone (tibia). They act as shock absorbers and stabilize the knee.” The lateral meniscus is on the outside of the knee joint, while the medial meniscus is on the inside.
A sudden, twisting movement of the knee can result in a torn meniscus.1 Trauma, such as a car accident, may cause a medial meniscus tear, but most often the injury seen in athletes.
The American Academy of Orthopaedic Surgeons says, “Sudden meniscal tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved.”2
Meniscus tears may also be the result of aging. When cartilage becomes thinner and weaker over time, it is more likely to tear.
Case focus: 60-year old patient
In 2010, Jarosz and Ames found that “conservative management of a meniscus tear through a chiropractic multimodal treatment approach provided an alternative or adjunctive therapy to routine orthopedic surgery” in the case of one patient.
In this case report, the patient was a 60-year old woman who went to her chiropractor because her left knee was swollen and painful. MRI showed that she had a medial meniscus tear.
This patient was treated with the following methods
- Therapeutic ultrasound
- Rest, ice, compression, and elevation
- Soft tissue therapy (effleurage and lymphatic drainage)
- Mechanically-assisted adjusting, using a handheld mechanical thrusting instrument
- Sports taping
- Rehabilitation to strengthen the surrounding musculature
The patient’s pain and function were monitored at the first, sixth, and twelfth visits, with consistent improvement.
Case focus: 54-year old patient
In 1994, Polkington reported a 54-year old woman experienced right knee pain for several months, and was diagnosed with a tear of the medial meniscus through MRI. Surgical removal of the meniscus was recommended, however, the patient preferred a conservative approach.
This patient was treated with the following methods:
- Mechanical force
- Manually assisted short lever chiropractic adjusting procedures
- Homeopathic therapy
The treatment led to “the patient recovering full function of the knee joint and achieving an asymptomatic status.
Multimodal success
Treatment plans are as individual as the patients for whom they are designed. Using a multimodal plan may provide the most efficient and effective relief. DCs have many tools available including manual adjusting, instrument adjusting, ultrasound, soft tissue mobilization, and many others. When you choose the most suitable modalities, you ease your patients’ pain to keep them coming back!
References
1 Cedars-Sinai. “Medial and Lateral Meniscus Tears.” https://www.cedars-sinai.edu/Patients/Health-Conditions/Medial-and-Lateral-Meniscus-Tears.aspx. Published July 2006. Accessed September 2015.
2 American Academy of Orthopaedic Surgeons. “Meniscal Tears.” http://orthoinfo.aaos.org/topic.cfm?topic=a00358. Published April 2009. Accessed September 2015.
3 Jarosz BS, Ames RA. “Chiropractic management of a medial meniscus tear in a patient with tibiofemoral degeneration: a case report.” J Chiropr Med. 2010 Dec; 9(4): 200–208.
4 Polkinghorn BS. “Conservative treatment of torn medial meniscus via mechanical force, manually assisted short lever chiropractic adjusting procedures.” J Manipulative Physiol Ther. 1994 Sep;17(7):474-84.
