Table Of ContentTHE KNEE
Clinical
Applications
A.LL.O GANS ERIEISN C lllROPRACTITCE CHNIQUE
The Knee: Clinical Applications
The Foot and Ankle: Clinical Applications
The Low Back and Pelvis: Clinical Applications
THE KNEE
Clinical
Applications
A.LL.o gan
Seriiens
Chiropractic
Technique
AlfreLd. L ogan,D C
AlfrLeL.do gan
Formerly associated with
Los Angeles Collegeo fC hiropractic
Whittier. California
and
Anglo·EuropeanC ollegeo f ChiropracliC'
Bournemoulh.E ngland
Witah c ontribbuyt ion
LindsayJ .R owe. MAppSc (Chiropractic).
LindsJaR.yo we MD. DACBR (USA).F CCR (CAN).
FACCR (AUST).F ICC
NewcaslleA.u slralia
�
AN ASPEN PUBLICA TION®
�
Aspen PublisherIsn.c .
�
GaithersburMga.r yland
1994
LibraorfCy o ngreCsasl nloging-in-PDautabl icntion
Log.nA.l fn:dL
The kneec:l iniacpapll icalionLsl.ALl ofgraend
p cm - (AL .L oga�nr ieisnc hiroprIacclcihcn ique)
Inclubdiebsl iograrpehficcraelan ncdei sn dex
ISBN()''8 342·0522·X
I Knce-Di�ascs-Chirolprrea3cllmcinct .
2.K nee-Woundsa ndi njuries-ChirIorper3alcmlcincl .
IT illIeIS. e ries
(DNLM'1 .Kn ee Injuries-dia2g.Kn noeseiI sn.j uries-lhcrapy,
3.K nee-physiopath4o Clhoigryo.p ractic-lWIEl C87l0h ods.
L8311k9 941
RZ265.K1.5.643 1994
617.5'82-dc20
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foLri braorfCy o ngress
93·39114
CIP
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copyinsgu,c ahs c opyifnoggr c nerndli slribuftoiarod vne,r tiosri ng
pronl()(ional fpoucrrpose.r se.ll lnienwgc ollcclivc wfoorrrek ssa.F loeor.r
informataidodnr.eA ssspe nP ublishIenr.cs.P . c nnisl;iDeopnasrt ment.
200 OrchaRridd gDer ivSeu.i t2e00 .G allhcl"'ibuMragr.y la2n0d8 78.
Thea uthhoars m adee vereyf fotrto e nsurteh ea ccuraocfyt hei nformation
herem.H owevearp.p ropriinmfeo rmatsioounr cessh oulbed c onsulleesdpe.
cialfloynr e wo ru nfamilpiraocre durIetis s.t her esponsiobfie lvietrpyyr acli
lionteol' evaltuhe3 alpep ropriateonfae psasr ticouplionri ionnt hec onteoxft
aclual csliitnuiactaailno dwn ist dhu ec onsidertaotn ieowdn c vclopmeTnhles
authoerd.i toDrnsdt. h ep ublishcrcbea hnenlordle sponsfiobarln eyl ypogrnphi
calorO Iheerr rofrosu nidnt hibso ok
EditorRieaslo urcAemsy'M artin
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ISBN()'' 8342·0522·X
Prmli�l,rl1lU l"�i lS�Id( l,,I!� ASm �rica
I 2 J 4 5
Anyonweh oh asb eetno s chocoaln r emcmbaetrl eaosnte t eachwehro sien nu
encien spihriemdt ol earmno ref ulltyoa, p precitahlese u bjebceii ntga ughaln,d
perhatposr ealialz ei few'osr. k hIa vbee en fOrleunnoautgteho h avhea ds everal
sucthe acheIrnhs i.g shc hoomly, b iololgeya chmeorv edm e inltoh sec iencaensd,
ah umanities teachienmr e t ihndese tsiiltrlotee h di nakn dr esaonW.h ilset udying
chiropraIfc otuincDd,r .A ..LL oganIf. i rmsetth imw henh ev olunladriidcl lyi ni
carlo undastt heL osA ngelCeosl leogfeC hiropraclic.
RoyL ogahna da capaci1l0uY n derslhaonwdt heh umanb odyw orksa,n da
curiosaibloYui ltt hakie phii mc onstanstelayr chainndgr esearcfhoiwrn agy s1 0
helhpe ai.llT hep rofessiisfo unlo lfp ersonallietaicehsi vnagr iaeo lflYe chniques,
somei nsisttihnegii rsts h eo nlwya y,b uti th asf ewt ruper ofesswohrocs a nc ull
thev ariotuesa chianngdsp .r esetnott h es tudean ctl eaarn dc onciwsaey t oa p
proacah p atiewnilt,h opuelr sonaalnidle Yg og elliinnIg h ew a.y Royh adt hese
abililainedfs,O, r lunafloeurls yh, e h ada d esi1r0el eacoht h.e rHsen ever missed
ano pporlunilY.
Hes awt hnee eidn o urp rofessfioaorw n a yt ol intkh reo tcel inisccaile nacneds
thev ariowuasy so fe xecutainna gd just.m Heen gtaveus a na nswetrot hec om
monlays keqdu esloifow nh ena ndw herteo a dju.Hs lew asc onstapnulslhyi Inhge
professtioor ne alitzhee i mportanocfee ffective calpipnliiccaalto ifo n
chiroprparcitnicci aptla te ism weh ent hersee emetdo mboe ree mphasoinsf itting
inltoh eh eahcha rien dusbtyrw ye arianw gh ilceo aaln du sinbgi gw ord.s
Arountdh we orlsdt,u deonftD sr .L ogauns eh imse thoodfsd iagnoasnidts r eal
mente verdya ya nda rer emindoefhd i wso ndercfounlt ributtoit ohneps r ofession.
Hel eclurreepde alebdelfyos reev ersatla atses ociatainodln asu,gI ah n e ighmlo nth
posl-gracdouuartasete L ACCf oeri gyhte arHse.w asC hairmoafnt hTee chnique
Departmaelntth eA nglo-EuroCpoelalne ogfeC hiroprafcotrfi icvy ee ars.
Ins piotfeh ism anyc ontributRiooyn'wsso, r kr emaiunnsf ini.s Hheep dassed
awayi nA priolf 1 993, aflfeirg hlail negnn inaill ln.e Hsesw asw orkinhga rodn
hisl extbooukps1 0I hee ndh,o pin1g0t ransafsem ru cho fh isk nowledagned
wisdo1m0p apearsh ec ould.
Dr.L ogahna sa n umbeorfs tudednetdsi ca1l0ce odn tinuhiinwsgo rka nds eeing
ite volivnet hwe ayh ee nviseido.Tn heriesn o" A.L. Logan Technbiuqtru aet,h"e r
ac ompilaotfiv oanr iotuesa chicnogmsb,i nweidt ahu niquuen derstanodfti hneg
inlerdependoeftn hcheiu emsa ns tructWuer heo.p e1 0d oh iwso rkj ustaincdes ec
morcs tudeonftc sh iroprabecctoimcea se ffectaispv oes siibnlt eh et reatmoefn t
humand isorders.
Table of Contents
Forewor.d...............................................................................9. ........
SeriPerse race II
............ ........................................... .......... .........•.•.•......
Prerac..e. ...... ...................... .................. ............ •............................. 13
Acknowledgme..n.t.s.. ... .. ..... .... .. . ....... ........... .. ........... ..... ........... ......... .. . J5
Chapte1-rA natomy. .............................................................................
.
BonyS tructu.r..e.s•. ...... .•.•...............•............•.. ........... . . . . . . . . . . . ..... I
Menisc.i.. ....................................................................... ...2 ...
Ligamen.t.s.. ......................•............. ......•.•..... ........................ 3
6
Bursa.e. ... ... ............................ •........•................•.•.•.•.•.•...•....
MusclAet tachments 7
Functional An..a.t.o..m.y•. .............. ..•........ . . . . . . . . . . . . . . . . . . ...•. ..•.•.•. • . . . . 8
Chapte2-rE xaminatio.n.. .... .................................... .•............ ........ ........ ... IS
Histo.r.y.. .......... . . . . . . . . . . . .............. .....................•.•.................. 15
16
Observat.i..o.n. .......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . ...........
ExaminaLFioonnn. . . . . ....... ....... . . ......•..... . . . . . • . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . 48
Chapte3-r- MusclTee stin.g. ...............................................................4.9 .......
.
Gradin.g. . . . ...... ...........•.•....•...•..... . . . ........ . . . . . . . . . . . . .•................ 49
Traun.1.3. .............................................................................. 51
SpeciMfuiscc lTee st.s. .................................... ............•.................. 51
MusclBea lanc. .e. . . . . .......•........•........•.•.•...............................•.•... 57
Summary. . . . . . . . . . . . • . . . . . . . . • . . ......•.....................•.•... . . . . . . . . . .. . .. . . . . . . . 58
Chapte4-rI maging 59
..............• .•............... ............................. ... ............ ....
Lindsay J. Rowe
ImagiMnegt ho.ds. ................................................................... ..5.9 .
Measuremeonftt hseK nee. ............................................................... . 63
66
CongeniAtnaolm aliaensdV arian.t..s. .................................................... ..
TraumatIincj ur.i.e..s. . ................................•......... . . . . . . . . . . . . . . . . . . ...... 70
ArthriDtiisco rd.e.r.s. . . ................. .............•..................•...•...•.•...•.. 78
Neoplas.m.s. . . . . ...................... .................•.•........................•.•.. 83
89
VasculDairs orde.r..s. . ........................•..........•...•..........................
Infect.i.o.n.s. ......................................................................... . 92
MetabolDiics orde.r..s. .... ....•......•...... . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Chapte5-rA djustive 99 Techniqu.e.s.. ............ ......... ...•.... ............... ....................
LateraRloltya tTeidb ioan t heF emur 99
MedialRloyt atTeidb ioant heF emur 103
AnteriToirb iFai xatoinot nh Fee mur 103
vii
viii THEKN EE
PosterTiiobriF ai xatoinot nh eF emur. ................. . . . . . . . . . .. . ............ .............. 103
LaterTailb iFai xatoinot nh eF emur. .................... .....•............................... 103
MediaTli biFai xatoinot nh eF emur. .......•..... ................................ . . . • . • ...... 104
PosterFiiobru Hleaa dF ixati.o..n. ..... ...•........•...... ..... ........... ..•. • . . . . . . . . ..... 105
SuperioFri buHleaa d Fixa.t.i.o..n. ...............•.................•.. ....•............... 106
AnteriFoirb uHleaa dF ixati.o.n.. ...............•............................. ............. 106
InrerFiiobru Hleaa dF ixati.o..n. .......•........•........•.................... ............. 106
SuperiPoart elFliax ati. .o. n . . . .. . .. .. .. . .. . .. . .. .. . .. .. . . .. .. . . . . . .. . . . . .. . . . . . .. . .. . . . .. . . 106
MediaMle niscEunst rapme.n..t. ...•. .......•........•.•... ............... ................. 107
LaterMaeln iscEunst rapme.n. .t. . .. . . ..•........•....... .•........•........•.•........•.. .. 107
Chapte6-r- ConditioannsdT herapy. .. ............. ..... .... .... ......... ............... ...... . ... ... 109
ChronKince eD ysrunctDiuoetn o P ostural .S..t.r.a.i. .n. . . . . . ...... . .. . . . . . . . . . ............... 109
KneeD ysrunctDiuoetn o O rganPirco blem..s. ............. ................... ................ 114
Strai.n.s.. ..... .. . . . . . . . . . . . . ... .......................................... ............. 115
TendiniatnidOs v eruPsreo blem. .s. . . . . . . . . . ... .. . . . . .... . . ................................. 128
Bursi.t . i. s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . .. .. . . .. . . . .. . 1. 3.0 . . . . . . • .
ChondromalPaactiea.l l..a . . .. . . . .. . . . .. . . .. .. . .. . . . . .. . .. . . . . .. . .. . . . . .. . . . . . . . . . .. . . .. . .. 131
OsteochondrDiitsisse ca. .n .s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . .. . 1. 3.3 . . . • .
Ligament Datmota hgeeK nee. .............. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... 133
MeniscTuesa r.s. . .. . . . . . . ......... ........................... ........................... 135
PostsurgPiactaile n.t..s. .............................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... . . 136
Chapte7r- ExercisaensdS tretch.e.s.. ............•........• .......................... ............... 139
Lordotic Lumbar S.y. .n.d..r.o..m.e. ................ ... . ................................. 140
GluteMuasx imuMsu scl.e. ..... ..... . . . . . . . . . . . . .............................. . ........... 143
Lateral Hip MuRsotcal.te os. .r . . . .. . . . . .. . .. . . .. . . .. . . .. .. .. . . . .. .. .. .. . .. .... . . .. . . .. ... .. 144
QuadricFeepmso rainsd Oblique Fibers oMreldhiea l.Vi.as.s.t.u.s. .............................14 4
PoplitMeuussc l.e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . .. .. .. .. .. . .•. ... . . . .. •... . .. .. .. .. . . 149
HamstriMnugs cle.s. . . . . . . . . . . . . . . . . . . . . . . . . ........•....................... ............. 150
TriceSpusr aMeu scl.e .s . . . . . . . . . . . . . . . . . . . . . . .. .. ... .. .. . • .. . . . . . . . . . .. . . . . . . . .. . .. . .. . . .. 151
SartorainudGs r aciMluissc le.s.. . . .. . . . . . .. . . . ............................................. 152
Chapte8r- CaseH isotrie.s. . . . . . . . . . . . . . . . . . . . . . . .. •. . .. .. .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ISS
CaseI 155
Cas2e 155
Case3 156
Cas4e 156
157
CaseS
AppendiAx- OrganiPcr oblemasn dt hKen ee .......... ......... ............... ...............•. ...... 159
Fixation-TOhregoarny. . ......................... . . . . . . • . . . . . . . . . . . . . . .•.................. 159
NeurovascDuylnaarm ic.s. . .................... . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . ..... 160
Organ-MusRcellea tion.s.h. i..p.s........ . .... ... . . .. . .... . . . .... . .. .. .. . . . .. .. . . . . . .. . .. .. 160
Methodolo..g.y....................................................................1.6.1 ...
Opinio.n. . . . . . . . . . . . . . . . .......... . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . ......... . . . . . . . . . 162
AppendiB-x Palpati.o .n .. . . . . . . . . .. .. . . . . . . . . . . . . . . •. .. . .. . .. • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 163
StatPiacl pati..o.n.. ...... .................... . . . . . . . . . .. ..... ...•............. .......... 163
MotioPna lpat.i.o.n.. ......•...................•.. .... ....................•..........•... 163
Passive MPoatlipoant i..o.n. ..................•........ •... . . . . . . .. . . . . . . . . . . . . . . . . . 164
Inde.x. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . .. .. . . . . . ..• . .• . . . . . . .. . . . . •. . . . . . . . . . . . . . . . .. 165
Foreword
Helpipnagt ietnetasc,h sitnugd eanntdsp ractitihoonwte or s knowledogffe u nctioannaatlo mayn dh istoarsyw ,e lals d ili
asseasnsd e valuattheep robleomfsp atienatnsda, r rivaitn g genotb serva.t Biootnhb ackgrouannddp roceasrsep rovided
optimtarle atmpelnatn wse res omeo f tlhaet Dc.r Roy here.
Logang'osa .l Tshis bporookv idtehser eadweirt ah s ystem Dr.L ogand edicahtiesdp rofessiloinftaeola ne xtensive
atiacp proa1c0ch a rryoiuntag n a ssessmaenndut n derstandinsgt udoyfn euromusculosskterluecttaaunlrdt e h eb iomechanics
three asobnesh intdh ev arioaussp ecoLftS r eat.m ent oft heb odyT.h ibso okp rovidtehser eadewrit ha thorough
TheK lleCel:i llAipcapll icaTfioollllosaw nso rderplryo understanodfti hnepg r actibciaolm echaonfit chsek nee.
gressfiroon mt hea natomoyft hek neet hrouegxha mination,I d eeplayp precimayt fer iendshipt hewl iattDehr .L ogan
includmiunsgc ltee stiwnigt.mh a nyi llustraantdia co hnasp ter andt heo pportutnoih tayv es penmta nyd elighhtofuurlws i th
oni maginAgd.j ustitveec hniqaurecas l so illucsotmratehdi m discussing bainoamteocmhya,na incdsp ,a tieansts ess
pletealsay r,et hec hapteardsd resscionngd itiooftn hsek nee, mentt,h eanr rivaitna gna djustoirmv aen ipulatteicvhen ique
theraapnyd,e xerc.i se supporbtyeo du rf indianngdso bservatIitoi nsms y. e xpecta
Thec haptoenrc ashei stordireaswo sn s omeo fD r.L ogan's tiotnh atth itse xitn,t endfeodbr o tsht udeanntdsp ractitioners,
mositn teresctliinngie cxaple rientcheedsye; m onstrtahteae r t wilolf fetrh emt hes ameo pportuntioit nyc reatshee iprr o
ofp roblseoml v.iT nhgee xaminatcihoanp tiesor r ganiiznea d fessioanramla mentarainudem n hancteh eicrl iniucnadle .r -
mannecro nsiswtietnhhte lpitnhgee xaminpeirn poipnrto ba stand.i ng
le.mT oc ompleatnea ssessmtehnepta tiemnuts tb ep roperly HerbeI.r MTa geeJ.r .D,C ,F lCC
andt horougehxlaym ineAdc.c uradtiea gnodseipse ndosna RedlVoCoidt yC,a lijomia
IX
Series Preface
". .. Thaep plicatoifop nr inci.p.le.isn volves Fromt hirse cognictaimoeno ver20 yearosf t eacnhg.i It
highemre nIaplr ocestsheastn h eimre morizing; wash ihso pet hahti isd eas would cgoennteirandtuieea dl ogue
eversyt udesnhto ulbde g ivean t horoudgrhi ilnl andi nteriens t expantdhienc gl iniacpapll icaotfic ohni ro
cliniacnaall yisniw sh ichhe s hould bet oms aedee practpirci nceisp. l
ther elationwshhiicpeh x isbtest weetnh ef unda D.r Logadni dc linircoauln dastt heLo sA ngelCeosl leogfe
mentafla catnsd t heir claipnpilciaocnla. "t i Chiroprascitniccte,h ee arlsye ven.t Hieesl ectuorfetde fno r
FrallMc.iP so ttellMgDe r, variosutsa atses ociatainodtn asu,g ahttt heA nglo-European
ColleogfCe h iropr.a Dcutriicntgh itsi mDer. Logacno ntinued
Thee ducattihoanat m odercnh iropraucntdoerr goiens tol earna ndg rowa sa clinicainadtn e ac.h Heirsd ecisitoon
cludetsh e clisnciiceanlc aensdt hem anipulaatri.tv se A writaes e rioefts e xotnst hce liniacpapll icaotfci hoinr opractic
graduadtocet oorf c hiroprhaacsta it ch orouggrha sopft hed i princicpalmeeso uto fh ise xperienicnle e achiunngd ergradu
agnosatnidcc linisckailla lnsdi st rainienbd a simca nipulativaet tee chniaqtAu EeC Ca nds eeitnhged ifficuulptpyed ri vision
techni.q Wuietsht hiksn owledtgheep, r actidcoicntgbo erg ins studenhtasdi nu nderstandingw hwehreean,n, d w hyt hey
tog aitnh ee xperietnhcaemt a kest hea pplicaotfit ohni s shouladd ju.s t
knowledsguec ceuslsA.f succesdsofcutlio sro new hoc ontin Thisse rioefst extbowoiklsbl e a comprehenrseifveer ence
uest ol earbne yonwdh aits m inimarlelqyu irfeodhr,e o rs hei s onc hiropraccltiincia cpapll icatDir.o Lnosg.a bne lievtehdi s
constanrtelnye weadn ds timul.a ted approaschho ulbdet heb asifso ra nu ndergradcuoautrcsi en
Dr.A .L.L ogawna sa s uccescshfiurlo praacd toocrt,to hra t, adjustainvdce l initceaclh niqIutie sa.,t t he satmiem ea,w el
likDe. .O Palmecro,n tintuoeed x panhdi su nderstanodfi ngc omea ddittioot nh ken owledogfae n yp ractitioner.
thheu manb odyi nh ealatnhdd iseaHsees .t uditehdwe o rks of
manyo ft hec hiroprapcrtoifce ssiloena'dsie ndgu ca.t oHres
researcahneddd e velopheids otwhne orwiheisc hhe a pplied
PottenFgMe.rS ymptoomfsV isceDriasle as5e.t. L ouis:
inh isp ractiacnedl, i kmeo stc hiropracdteovresl,o paes du c
Mosby1;95 3.
cessfduilv.e rsiafpiperdo atcohd iagnosainndgt reathiinsg
pati.en Dtr.s Logarne cognitzhenede efdo arp ractiwcaaytl o
blenbda siacn da dvancmeadn ipulatteicvhen iqwuietsch l ini ChriHsu tchesDoCl l,
caslk i.l ls AubumC,a lifomia
xi
Description:Health Sciences & Professions
