Picture
The tensor of vastus intermedius is respresented by the "Red 1" in this diagram.
MEDICINE IS STILL AN IMPERFECT SCIENCE, EVEN WITH QUANTIFIABLE TRUTHS.  

Anatomy can, and does, change.

The image above is a comparison of a normal Left thigh (quadriceps muscle group) with the newly discovered muscle in RED, the kneecap (patella) is located at the bottom of the image.  Traditionally, there are 4 muscles that compose this group: Vastus Lateralis (2-VL), Vastus Intermedius (3-VI), Rectus Femoris (5-RF) and Vastus Medialis (6-VM).  Here is a link to the article by Grob et al (2016), recently submitted to the journal Clinical Anatomy. http://www.ncbi.nlm.nih.gov/pubmed/26732825

Because anatomy rarely changes, it is exciting for the scientific and medical communities when research such as this is released.  As I just stated, traditionally the quadriceps consist of 4 distinct muscles on the front (anterior) portion of your thigh.  These muscles act mainly as knee extensors (i.e. kicking a ball in front of you) and contribute slightly to hip flexion.  

Considering I am currently teaching lower extremity anatomy in my undergrad course, I will absolutely investigate some cadavers in the upcoming week.  Let's see what I can find...

What's the big deal?
The finding of this muscle, which was identified on 26/26 cadavers in this study, implies that the Vastus Intermedius (3-VI) is impacted by a separate and independent structure.  This structure was given the name "tensor of vastus intermedius", as it's contractile fibers apparently pull/tense the larger vastus intermedius muscle.  This study also indicates this new structure is supplied by distinct blood vessels and nerves, further contributing to the notion that this is an true muscle.  The ramifications of this research would likely impact imaging procedures like MRIs, physical therapy/corrective exercises, massage techniques and certain surgical procedures.


Although our understanding of the human body is quite extensive...nothing is 100% accurate. MEDICINE IS STILL AN IMPERFECT SCIENCE, EVEN WITH QUANTIFIABLE TRUTHS.  We as humans are fallible creatures and therefore anything we participate in has fallibility, including the assessment of anatomy.    

Another Example:

To illustrate this point again, look at the image of a Right knee below.
Picture
The Anterolateral Ligament is a recently discovered ligament located on the outer aspect of the knee joint.
The structure labeled the Anterolateral Ligament is a relatively new discovery, the corresponding study was published in 2013 int he Journal of Anatomy.  http://www.ncbi.nlm.nih.gov/pubmed/23906341
The researchers hypothesize that this ligament is responsible for limiting certain rotation forces in the knee joint.  Additionally, this ligament may actually be the structure damaged when ACL injuries are thought to occur.  This notion may support the relatively high number of unsuccessful ACL repairs.

I hope you share in my excitement as we introduce the world to the tensor of vastus intermedius.  Ok, maybe not the whole world, but rather the finite group of anatomy dorks like myself.  As always, I value feedback and look forward to hearing from you.


Be Blessed!
-Dr. K
 
 
"TO BE HONEST, I DISCOVERED A CAROTID BRUIT IN A PATIENT DURING MY FIRST YEAR OF PRACTICE.  IT WAS A COMPLETELY JARRING EXPERIENCE."

Patients everywhere are beginning to question the necessity of a chiropractic manipulation...HERE'S WHAT YOU NEED TO KNOW.

It's all over the news: Model Katie May passed away at the age of 34.  Here is just 1 article of many describing the situation:
 http://www.nydailynews.com/entertainment/gossip/model-katie-death-fall-photo-shoot-article-1.2521755

This type of story tends to circulate around the media every time a similar situation occurs in our field.  Unfortunately, it perpetuates the general public's fear of chiropractors.  There is NO DIRECT CAUSE-EFFECT RELATIONSHIP BETWEEN STROKES AND CHIROPRACTIC MANIPULATIONS.  HOWEVER, IT IS A VERY REAL RISK FACTOR THAT ALL CLINICIANS AS WELL AS THEIR PATIENTS NEED TO BE AWARE OF.

The trauma she experienced on a photo shoot that led her to believe she was experiencing a pinched nerve, was likely the injury that resulted in a tearing of her carotid artery.  Check out the image below for the anatomical and pathological significance of this condition. 

Essentially, a tear occurs within the artery itself, leading to a blood clot (which is your body's attempt to repair the damaged structure).  This blood clot, or fragments, may then become dislodged and travel downstream to important structures in the face and brain.  Once the clot (or fragments) reach a small enough blood vessel that is impassable, nutrient deprivation occurs to that area.  Certain signs and symptoms should be evident at this point.  Unfortunately, prior to this stage of the condition, signs and symptoms may be relatively vague...such as neck pain.
Picture
http://www.riversideonline.com/source/images/image_popup/ans7_carotid_artery-dissection.jpg
The American Stroke Association estimates that 10% of strokes occur in people under the age of 45, like May.  Most of you probably associate stroke with the elderly population but this is a dangerous misconception.  Now, although I am obviously a chiropractor, I am not going to blindly support the chiropractor involved in this case.  WHY?  Because there are necessary questions and procedures to medically rule in or rule out stroke as a diagnosis.

FAST is the acronym regularly advertised by the American Stroke Association now and is a great tool for the general public's recognition of a medical emergency.

Face
Arm
Speech
Time

More specifically, look for:
Face-drooping or face numbness
Arm weakness or arm numbess
Speech difficulty or slurred speech
Time to call 9-1-1 as these symptoms indicate a medical emergency.

HOWEVER...when a patient presents to a doctors office with vague neck pain induced by trauma that is not improving, a more thorough clinical investigation should follow.  While nothing is 100% accurate, there is a significant likelihood that if your neck pain resulted from an arterial dissection, the following will assist the clinician in determining the cause.  If a carotid dissection is expected, the patient should have a doppler ultrasound of the carotid artery to determine the severity of the clot or plaque build-up.

So here are the steps I take in my office to rule out the possibility of stroke.  
Ask the 5 Ds And 3 Ns in the office for anyone with neck pain or headaches as well as auscultation of carotid arteries to detect a bruit (an abnormal whooshing sound).
5 Ds
Diplopia (double vision)
Dysphagia (trouble swallowing)
Dysarthria (trouble speaking)
Dizziness (vertigo-like symptoms)
Drop attacks (spontaneous falls)

Ataxia (loss of controlled bodily movements)

3 Ns
Numbness (abnormal sensations)
Nystagmus (repetitive, uncontrolled eye movements)
Nausea (uneasiness of stomach)

Auscultation of carotid artery below:
Picture
https://i.ytimg.com/vi/aTub9RP7Uuk/hqdefault.jpg
TO BE HONEST, I DISCOVERED A CAROTID BRUIT IN A PATIENT DURING MY FIRST YEAR OF PRACTICE.  IT WAS A COMPLETELY JARRING EXPERIENCE.  I am in no way trying to "toot my own horn".  It is necessary for those of you reading this to know that I do take the medically necessary steps to determine the cause of your pain and will absolutely refer to other medical providers if indicated.

There are risk factors associated with any and every medical procedure...from a basic blood draw TO chiropractic manipulations TO medications TO surgical interventions.

I hope that you realize that the media has portrayed this inappropriate connection between chiropractors and stroke.  If you seek care from ANY MEDICAL PROFESSIONAL: ASK ABOUT POSSIBLE RISKS ASSOCIATED WITH THE PROCEDURE.

As always, I look value feedback and look forward to hearing from you.  
Be Blessed!
-Dr. K
 
 
The MOST IMPORTANT QUESTION in physical medicine:
WHY DO YOU HAVE PAIN THERE? AND HOW DO WE FIX IT OR MANAGE IT?


Scrolling through Instagram...(yes we all do it)

I came across a great clip demonstrating a complex connection through a basic exercise.  Since my last few posts have had little to do with human movement/anatomy, it is about time I share some knowledge of this topic.  After all, that's the focus of my practice.

Do you know someone with hip, knee, ankle or foot pain?  I'm sure that all of us could think of a friend, family member, co-worker, classmate or colleague that has one of these ailments.  Many patients come into my office and assume that because their knee hurts...their knee is the problem.  Usually, they're wrong.

IN MY WORLD OF HUMAN ANATOMY, THE SITE OF PAIN AND THE CAUSE OF PAIN IS OFTEN NOT THE SAME. ( a previous post of mine on this topic, 
http://dynamicphysicalhealth.com/2/post/2015/07/it-hurts-righthere.html)

Check out the photo below, then I'll explain.
Picture
http://image.slidesharecdn.com/shupe-140306132711-phpapp02/95/pudendal-neuralgia-and-lower-extremity-feet-biomechanics-ics-2011-glasgow-scotland-20-638.jpg?cb=1446317327
Let's look at the image on the LEFT (with posterior at the top).

I am going to attempt to explain this in non-medical terms, as well as  anatomical/medical terms.
Everyday Terms:
START:
Tilt your butt backwards OR tuck it underneath...
-this leads to your hip joint rotating outward slightly
-this leads to torque on the knee joint, force is outward
-this leads to your lower leg rotating outward slightly
-this leads to a slightly higher arch in your foot
Medical Terms:
START:
Posterior pelvic tilt...

-leads to hip external rotation

-leads to external rotation torque at tibiofemoral joint 
-leads to tibial external rotation

-leads to supinated foot position
I tried to coordinate the 2 sides to make it easy for the visual learners reading this post.  Actually try this at home...perform a posterior pelvic tilt (or tuck your butt underneath yourself) and see what happens.

DO YOU FEEL THE MOVEMENTS I DESCRIBED?

If you do...great!  If you do not...you may lack adequate gluteal activation or have other issues along this entire kinetic chain (which also extends well above your hip by the way).  Next time you have pain anywhere along this chain, think of this basic movement and how all of these areas are SYNCHRONOUSLY CONNECTED.  So, if you seek care from a movement professional like myself and they start evaluating a different area of your body, realize this is fairly normal in our world.  By the way, this kinetic chain is just one example of the many bio-mechanical connections throughout the body.  Yes, the shoulder blade not moving properly can effect the wrist...crazy, I know.  Yes, the neck can effect the feet...crazy, I know.  


The reason for this post is 2 fold---- 
1. To demonstrate I actually understand and apply my physical medicine knowledge (other than write about doctor-patient relationships)  

2. To illustrate that although helping people "get out of pain" seems rather straightforward, it's not.  

Clinicians like myself have a whole host of observations to make, questions to ask and tests to perform to answer the most important question in physical medicine...

WHY DO YOU HAVE PAIN THERE? AND HOW DO WE FIX IT OR MANAGE IT?

I have included a brief video demonstrating this movement, hopefully this helps.  Notice the movement at my feet (although minimal).  And please...TRY THIS AT HOME.  As always, I value feedback and look forward to hearing from you.

Be Blessed!
-Dr. K
 

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    Erik Korzen DC is a chiropractic physician and educator.  He is passionate about re-defining the chiropractic profession and is somewhat of an "Anatomy Geek".

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