Archive for the ‘Applied Kinesiology’ Category

If you’ve ever gotten (or given) a massage, you probably noticed that some muscles have painful little lumps or knots in them. They’re sometimes (enjoyably) painful when massaged or prodded; although the worst-case scenario can be constant pain during typical activities of daily living. The technical term for a knot like this has been coined “trigger point” by JFK’s doctor, Dr. Janet Travell.

The typical presentation of symptoms arising from trigger points are painful restricted range of motion and/or dull, aching or sharp muscle pain. Additionally, trigger points can cause referred pain. You may be familiar with the concept that oftentimes when someone gets a heart attack, they will experience pain down their left arm. This is a classic example of referred pain due to (cardiac) muscle damage. The same concept goes for skeletal muscle and/or fascia. I’ve even had instances where patients thought they were having a heart attack, but it was actually referred pain from a trigger point in their chest (pectoral) muscle.

There are basically two types of trigger points. One involves muscle fibers while the other involves fascia, the soft connective tissue that covers every muscle and permeates the entire body. It’s not important for you as a patient to know the difference, however it is for the doctor because the way it’s treated will depend on whether the problem is in the muscle or the fascia.

Trigger points can develop for any number of reasons. Postural distortions very often cause and/or exacerbate trigger points. Another common reason would be a (quick) change in position after being sedentary for a long time. A classic example is someone who is crouched or kneeling while gardening and then suddenly stands up. This commonly results in trigger points in the hip flexor(s) and often leads to low back pain. Theoretically, the muscle is “stuck” in the crouched position and hasn’t adjusted to the standing posture appropriately. This same scenario can take place under any circumstances involving changes in position, especially if they are sudden.

An inhibited or truly weak muscle can also result in trigger points. Typically, the trigger point will be in a synergistic (i.e.: one that performs the same or a similar function to the weak one) and/or the antagonistic (i.e.: a muscle that acts opposite the weak one) muscle. A synergistic muscle would develop trigger point(s) because it has to work harder and make up for the weak one; while an antagonistic muscle can develop trigger points because it tends to shorten and tighten due to a lack of sufficient opposing forces. Typically the former will result in a trigger point in the muscle, and the latter will often involve more of the fascia. This triad of muscle dysfunction is very common in musculoskeletal injuries and pain, and correcting these aberrant muscle patterns and trigger points often makes all the difference between success and failure. Fortunately, treating a person with pain that arises from trigger points is fairly straightforward, simple, and easy to resolve.

If however, a person tends to have trigger points “all” over their body or chronic recurring trigger points, nutritional deficiencies should be considered. In Dr. Travell’s book, “Myofascial Pain and Dysfunction, The Trigger Point Manual”, she mentions inadequacies of vitamins B1, B6, B12, folic acid, and vitamin C; and inadequacies of the minerals calcium, iron, and potassium as potentially aggravating factors. I would add the mineral magnesium to that list as well, because of its ability to act as an anti-spasmodic.

Generally speaking, we all have trigger points in our muscles and/or fascia to some degree. What matters is how much they are contributing to pain and joint dysfunction.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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You may have heard of the condition known as plantar fasciitis. If not, the word “plantar” refers to the sole (or plantar surface) of the foot, and “fasciitis” means inflammation of fascia. Therefore, plantar fasciitis refers to inflammation of the fascia that covers the sole of the foot. Fascia is simply soft connective tissue that exists throughout the body. It covers every muscle, bone, joint, organ, blood vessel, nerve, lymphatic vessel, etc.. Essentially, it helps support the structure of the body and provide some protection due its ability to act as a shock absorber.


The main symptom of plantar fasciitis is pain on the sole of the foot, especially on the heel. Additionally, it tends to hurt the most just after stepping out of bed in the morning, and may get better as the day goes on. However, it may also get worse with walking.


The primary cause of plantar fasciitis is overpronation of the foot; which is also referred to as “flat feet” or “fallen arches” in lay terms. If you think of the foot and its (plantar) fascia as a bow and arrow, the fascia would be the string and the bow would be the bones of the foot. In a biomechanically-sound foot, an arch is present which gives it the bow-like structure. Now, imagine if the arch (or bow) “dropped” (or straightened) as in overpronation; then picture what happens to the string on the bow (i.e.: the fascia). Essentially, it will have to stretch to accommodate the “flattening out” of the bones of the foot. It is this stretching and excessive tension of the fascia that can lead to the painful condition known as plantar fasciitis. Other factors that can contribute to plantar fasciitis are excessive pounding on the foot (as in jogging or jumping) and a tight achilles tendon or calf muscle.


Conventional treatment can include the use of orthotics, anti-inflammatory medication, and stretching exercises.

Chiropractic and applied kinesiology treatment consists of correcting the cause of the problem. If this relates to overpronation, the muscles and joints of the foot and lower leg need to be evaluated and treated appropriately. Certain muscles may need stretching and lengthening, while others need strengthening and shortening. Also, joint motion will most likely need to be restored in the foot and ankle with chiropractic adjustments. The integrity of the ligaments may need to be supported through specialized applied kinesiology treatment and possibly through nutritional supplementation. Also, supplements to assist with quelling inflammation and to speed healing may be warranted. If necessary, orthotics may be prescribed to assist in maintaining the structural integrity of the foot. Whether or not orthotics need to be used permanently depends on the severity of the problem. Most importantly, a treatment plan needs to be designed to fit each individual’s needs.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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The rotator cuff makes the headlines in shoulder pain as much as the sciatic nerve in low back and leg pain. It’s almost like referring to any brand of tissue as a “Kleenex®”, as if they are one and the same. Because it’s so popular, I thought I’d talk about it a bit.

The rotator cuff is a group of four different muscles that help stabilize and move the upper arm bone (humerus). Specifically, the rotator cuff helps stabilize the ball-and-socket (or gleno-humeral) joint of the shoulder to prevent a dislocation; as well as help raise and rotate the arm. The muscles of the rotator cuff include the supraspinatus, infraspinatus, subscapularis, and teres minor. Usually, injuries to the rotator cuff involve a tear or degeneration of the tendon(s), most often the supraspinatus tendon.

The supraspinatus tendon is tucked under the (acromio-clavicular or AC) joint formed between the collarbone and the tip of the shoulder blade (acromion). This joint is on the top of the shoulder where the strap of your bag may rest. The supraspinatus tendon often becomes compromised during activities that include prolonged overhead movements; such as in sports like baseball, volleyball, tennis, acrobatics, etc.. Essentially, the tendon continuously gets damaged (possibly leading to a tear) from being “impinged” under the AC-joint. This can result in pain, weakness, and/or limited range of motion of the arm. There are other ways that injuries to the rotator cuff muscles occur, but impingement is a common one.

Now, when an injury involves damage to the rotator cuff muscle(s), they are usually deemed to be the problem. Conventional treatments are often directed at exercises for rehabilitating the rotator cuff, therapeutic ultrasound, oral or injected anti-inflammatories, or surgery in severe cases.

My approach to rotator cuff syndrome is a bit different. I usually find that injuries to the rotator cuff muscles and tendons often do not stem from an inherent problem with the rotator cuff. Instead, I usually find that the main problem lies within the larger muscles of the other shoulder joints that help to prevent the humerus from “impinging” under the AC-joint; and that help stabilize the shoulder blade and collarbone. Usually, when I get the other, larger muscles firing properly and restored to their normal length, the rotator cuff muscle(s) will not become compromised and then allowed a chance to heal and function properly. Additionally, I evaluate the joints and correct the movement of the shoulder blade, collarbone, and humerus when necessary. Specialized treatments for ligaments, tendons, connective tissue (fascia), and even skin may also be employed. Lastly, evaluating the cervical spine for joint dysfunction is critical, as the nerves that exit the cervical spine control the muscles of the shoulder. Eventually, a rehabilitative program targeting the appropriate muscles causing the problem is undertaken. This is aimed at preventing a recurrence of the problem and a return to normal activities.

So even if you’ve been diagnosed with rotator cuff syndrome or impingement syndrome; it would be prudent to have your entire shoulder complex and cervical spine evaluated for dysfunction to determine the ultimate cause of the problem.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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The trigeminal nerve is the fifth cranial (originates in the cranium/brain) nerve. It is responsible for giving us sensation on our face. Trigeminal neuralgia (aka: tic douloureux) refers to a condition where there is pain over the area that this nerve supplies. There are three sections of this nerve that supply sensation to either side of the face; as a result pain can be experienced in the eye, lips, nose, forehead, scalp, cheek, and/or jaw. Click here for the trigeminal nerve’s distribution.

This condition has often been found to be instigated by a cold breeze on the face (such as sleeping or driving with a window open), shaving, chewing, brushing your teeth, extreme opening of the mouth (such as in yawning), or sometimes for no known reason. Other, more serious problems like multiple sclerosis and tumors may be a cause. The more common reasons for changes in the function of this nerve have been deemed to be due to inflammation from an infection or pressure of a muscle or blood vessel.

The standard medical treatment for this condition is typically anti-convulsants, muscle relaxers, or maybe antibiotics (if it’s secondary to an infection). If medication doesn’t work, surgery may be the next step in conventional treatment.

My personal approach to this disorder is to restore proper motion and function of the cranial bones that this nerve passes through. This would include gentle cranial bone and cervical spine adjusting, in addition to balancing the muscles of the head, neck, and TMJ. Other factors affecting the alignment of the cranial bones, cervical spine, and TMJ would definitely need to be considered as well; which may include correcting the biomechanics of the pelvis and feet.

Nutritional considerations might include supplements that help control inflammation, reduce muscle spasms, and/or up-regulate the immune system. The most important thing to consider is that we are all individuals and treatment is based on your specific needs.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

sources: http://www.icakusa.com/ + http://www.mayoclinic.com/health/trigeminal-neuralgia/DS00446

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The temporomandibular joint (TMJ) can be considered the most important joint in the body. In the 1950’s, two neurologists, Penfield and Rasmussen, stated that almost half of the motor and sensory nerves in the brain relate to the dental area. With this much attention being devoted to the dental area, you can be sure the TMJ has a large effect on overall body function.

Symptoms of TMJ dysfunction typically include the following: jaw pain, clicking or popping in the joint, decreased mouth opening, headaches, neck pain, tinnitus (ringing in the ears), and vertigo or dizziness. However, because of its large representation in the brain, I check it in on almost all my patients. Other than musculoskeletal complaints, endocrine gland imbalances can also result. This is because the “master” endocrine glands, the pituitary, hypothalamus, and pineal reside in the skull. And because structure determines function, these glands can dysfunction (and affect other glands they control) if the cranium is distressed due to muscular imbalances in the TMJ. Symptoms can vary and include but are not limited to: infertility, insomnia, hypo/hyperthyroidism, adrenal stress syndrome, PMS, increased or decreased appetite, digestive disturbances, etc..

Causes of TMJ dysfunction include muscular imbalances in the head and neck, faulty posture, malocclusion (irregular contact of the upper and lower teeth), grinding or clenching the teeth, chewing on only one side, pelvic imbalances, and even over-pronation in the feet.

Treatment of the TMJ generally includes leveling the head on the neck through chiropractic adjustments to the cervical spine, in addition to balancing the muscles of the neck and jaw. However, as stated above, the pelvis and feet can play a role in TMJ function as well.

The TMJ usually becomes dysfunctional because of other areas of the body that affect it; unless there has been direct trauma to it, as in boxing or a head injury. Therefore, I rarely go straight to the TMJ. But it is certainly worth checking no matter what the patient suffers from.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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The piriformis is a muscle that originates from the anterior (or front) part of the sacrum and inserts into the greater trochanter (the large “bump” on the outside of the upper thigh) of the femur. Its action is mainly to externally rotate (or “turn out”) the femur and hip.

The sciatic is a bundle of nerves composed of nerves from the lower spine (~levels L4-S3) and usually runs it course under the piriformis. Interestingly, it is believed that in roughly fifteen percent of the population, the sciatic nerve actually goes through the piriformis muscle.

Piriformis syndrome occurs when the piriformis is overly contracted, shortened, or tight and puts pressure on the sciatic nerve. The result of this is typically (the proverbial) “pain in the butt” and possibly down the back of the thigh, and sometimes pain that radiates into the low back.

Now, the question remains: “Why is the piriformis overcontracted, shortened, or tight in the first place?”. Well, realize that there are basically two muscles that cross and thus stabilize the sacroiliac (or pelvic) joint on either side. These are the gluteus maximus (or buttock muscle) and the piriformis. Typically when I encounter a patient with piriformis syndrome, I find the gluteus maximus to be under-functioning; i.e.: neurologically inhibited. As a result, the piriformis seems to be left to do the job of stabilizing the sacroiliac joint on its own. Obviously, by design, it was meant to have the help of the gluteus maximus muscle, and without it the piriformis may reflexively over-contract or shorten to give the most support possible. The result is then excessive pressure or irritation to the sciatic nerve. Bear in mind that there can certainly be other causes of piriformis tightening or contraction, however the example just mentioned seems to be the norm in what I’ve encountered.

Standard treatment is generally aimed at stretching the piriformis, in addition to deep massage and perhaps anti-inflammatory medication.

Typically, I’ll look to the reasons behind gluteus maximus muscle inhibition if I find that is the major cause of the tight piriformis. This can include pelvic joint dysfunction, ligament laxity in the pelvic joints, lumbar (low back) and sometimes cervical (neck) spine joint dysfunction, lower extremity (hip, knee, ankle, and/or foot) dysfunction, and in some instances nutritional deficiencies.

I aim to address the cause of the piriformis dysfunction in the first place. I have many patients who do not stretch their piriformis and still do not have piriformis syndrome; so we can be certain that the cause of piriformis syndrome is not a lack of stretching. If it was, everyone who didn’t stretch that muscle would have piriformis syndrome. Don’t get me wrong, stretching is often indicated, however my point is that the cause of the tightness needs to be addressed or this problem will generally recur and perhaps cause other complications.

There may also be a problem with an inhibited priformis on the opposite side or inhibited internal hip rotators contributing to or causing the problem. Because of the inter-relatedness of all parts of the body, there can be any number of primary causes for this condition. This article is meant to be a general introduction into the problem, so I’ll leave it there.

All in all, the muscles that support the pelvis should be evaluated for dysfunction. And the alignment and motion of the pelvic joints and lumbar spine need to be restored. Specialized treatment for ligaments, tendons, and fascia (connective tissue) may also be required. A home stretching and strengthening program may be given to help support the treatment, while helping prevent a future recurrence. Nutritional supplements designed to increase healing and reduce inflammation may also be of benefit.

Strangely enough, doctors used to doubt that piriformis syndrome even existed, but that thinking seems to be obsolete now . Dr. Janet Travell, John F. Kennedy’s doctor certainly believed in the occurrence of piriformis syndrome; as she has been reported to say that it was more common than spinal disc herniations (or “slipped disc”) as a cause of back pain.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Recently I’ve realized that the most popular search term that guides people to my website is “ileocecal valve” (and variations thereof). Because of this, I thought I should write a few more words about the significance of it. If you are not familiar with the ileocecal valve, please refer to this article first, which explains the basics.

As mentioned in the first article, the ileocecal valve can either be stuck “open” or “closed”. I put those words in quotes because that might not literally be the case; however, it gets to the point and keeps things simple. When the valve is causing a problem, it is usually found to be open about 95% of the time and closed about 5%. Symptoms of both can be similar, but constipation is certainly a hallmark of the closed variety.

The reasons for dysfunction are also similar, but a closed valve is basically caused a hypertonic or spasticity in the intestinal muscles. This can be caused by excessive abdominal workouts, especially if done isometrically (i.e.: simply contracting the muscles without moving the torso). The next most obvious reason is nutrient deficiencies that cause muscle spasms in the first place. Remember the intestines are made of muscle, not skeletal (or cardiac), but smooth muscle. The most common nutrient deficiencies would be magnesium, or lack of available/usable calcium, not necessarily a deficiency in calcium. Hypochlorhydria, or low stomach acid (and/or digestive enzymes) is also usually an issue. There may be other causes, but those are the ones I typically see.

Other issues that accompany (perhaps the result, not necessarily the cause of) a closed valve might be things like intestinal yeast overgrowth (or candida), parasites, protozoa, bacterial and viral infections in the intestines. This can be the cause or result of insufficient “good” bacteria in the gut. Think hypochlorhydria; excessive sugar, refined carbohydrate, and/or fruit consumption; food contamination, and drinking chlorinated water, when it comes to gut flora imbalances. Symptoms on the other hand would be anything that accompanies constipation, such as bloating, abdominal cramps, flatulence, fatigue, general poor digestion, headaches, halitosis, low back pain, etc..

An open ileocecal valve can be the result of poor abdominal or pelvic floor muscle tone, leading to a general ptosis (drooping) or flaccidity of the intestines because of lack of support. Usually however, this is also due to gut flora imbalances along with the presence of pathogens related to the reasons mentioned above. An open valve can also result from irritation to the lining of the valve and intestinal wall in general. This is mainly due to foods high in roughage such as: popcorn, chips, nuts, seeds, spicy foods, alcohol, and sometimes chocolate and caffeine. This is especially true if those foods are not chewed thoroughly. By the way, I’ve found an open valve in just about every person who adheres to a strictly “raw food” diet. Chew properly and thoroughly if this is you!

Symptoms of an open valve mainly include loose stools, bloating, flatulence, general poor digestion, low back pain and lumbar disc herniations (without an onset of obvious trauma – i.e.: not simply bending down to pick something up), fatigue, headaches, halitosis, etc.. Hmmm, sounds just like a closed valve right! Remember, this is essentially a digestive problem, just like the closed variety; with the main difference being a possible magnesium or calcium deficiency in a closed valve. Again, consider hypochlorydria and insufficient digestive enzymes as well.

Unresolved emotional issues should be ruled out in either case. And pelvic and lumbar spinal joint dysfunction must also be addressed because the nerves that control the intestines arise from those areas. The fist lumbar nerve root (or L1) directly innervates the ileocecal valve. But again, I would check the entire lumbar spine and pelvic joints, including the sacrum.

I hope this sheds some more light on the topic as it is an important one. I check it on just about every patient, every visit, and definitely in cases of low back pain, headaches, and digestive disturbances.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology




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