Introducing The McKenzie Method

McKenzie Method of Diagnosis and Treatment

At Knoxville Spine and Sports, we have the benefit of offering patients a multi-disciplinary approach that is well-researched and proven in both literature and the clinic. We are pleased to have two physical therapists on staff who are certified in the McKenzie Method of Diagnosis and Treatment, or Certified MDT.

What is the McKenzie Method?

McKenzie treatment is widely known for a select few exercises that treat a bulging disc in either the neck or back, but the McKenzie Method of Diagnosis and Treatment is much more than that. It can be used for every joint in the spine and the upper and lower extremities. The McKenzie Method was developed by Robin McKenzie, a physiotherapist from New Zealand. The Method was introduced in North America in the 1980’s and has grown to become an internationally recognized method of treatment. To become a certified MDT therapist, clinicians complete 108 hours of classroom and hands-on training from the McKenzie Institute and are required to pass a written and clinical examination to demonstrate comprehension and appropriate technique. 

How is the McKenzie Method Unique?

McKenzie MDT is different from typical physical therapy in a few ways. It is an assessment process that allows a clinician to classify the patient’s issue into one of four classifications: derangement, dysfunction, posture, and other. These classifications help to guide the clinician’s decision-making process, not only at the evaluation but throughout treatment because it is an ongoing assessment process each visit. These classifications, however, are not “cookie cutter” guidelines that mandate every patient with a certain diagnosis received the same exercise regimen. The McKenzie Method focuses the clinician’s assessment to allow an individualized treatment program to be developed. Another difference is that the MDT classification is not based on a pathoanatomical model, in which the diagnosis or pathology present drives the clinical decision making. For instance, if a patient has a diagnosis of rotator cuff tendinitis, with or without radiological evidence (x-rays, MRIs, etc.), the MDT clinician does not design a treatment program based on the diagnosis alone. A typical treatment would start with a set of predetermined rotator cuff strengthening exercises based on the presenting diagnosis and a few clinical tests for impingement or weakness. But with MDT, the patient is given a thorough history and physical exam, including repeated movements of both the shoulder and neck, to determine if in fact the suspect rotator cuff is the cause of the patient’s issue. This ensures that patients begin treatment with the exercises that will best suit their individual needs. 

Better Outcomes?

The McKenzie Method of Mechanical Diagnosis and Treatment is patient-centered and patient-driven. From the first visit, the emphasis is determining what the patient can do to alleviate his or her problem. Throughout the evaluation and each treatment visit, the patient is educated about his or her issue and guided through how best to treat and manage the issue, both for recover during that episode of care and for the prevention of future episodes. 

Many patients have experience the ability to rapidly reverse lower back and neck pain through Mechanical Diagnosis and Treatment. Come and find out what you can do to alleviate the pain that is limiting your activities and life. Discover the difference for yourself and find out what we mean by Together for Health.

Spotlight: “Jumper’s Knee” in Basketball Players

Spotlight: “Jumper’s Knee” in Basketball Players

You’ve felt it—that ache that starts in the front of your knee after you play basketball or any jumping sport like volleyball or gymnastics. It came on slowly at first, but now you feel it more and more every time you play.

You are likely experiencing jumper’s knee. The official medical term is insertional tendinopathy, referring to the stress overload of the tendons that attach to the kneecap. It’s a common injury for any male or female athlete who performs jumping motions in their sport.

What Causes Jumper’s Knee?

Doctors believe that jumper’s knee is caused by repetitive stress on the patellar and quadriceps tendon. The injury is athlete-specific, appearing in sports that involve jumping motions—basketball, volleyball, or track and field high jumping or long jumping. It is sometimes seen in soccer players, too.

There are certain risk factors, such as higher body weight, anatomical knee features, landing technique, overexertion during training, landing on hard surfaces and gender. If your hamstring or quadriceps muscles are not very flexible, you’re also at higher risk.

Doctors usually classify jumper’s knee in four stages:

  • Stage 1 is painful only after sports activity.
  • Stage 2 is painful during and after the activity. The pain may be intense enough at this stage to interfere with sleep.
  • Stage 3 involves prolonged pain during and after the activity, and impacts your ability to play the sport.
  • Stage 4 involves a complete tendon tear that requires surgery to repair.

How Do You Relieve Pain From Jumper’s Knee?

Most people respond well to modified activities to reduce tendon stress, as well as physical therapy and loading exercises. Ice therapy for 20 minutes after activity helps, too. Stabilizer braces or orthotics can provide stability and reduce stress loads.

Stretches can help a great deal. Flexor stretches in the knee and hip to stretch the hamstrings, gastrocnemius, iliopsoas, rectus femoris and adductors help, as do hip and knee extensor stretches to work the quadriceps and gluteals. There are also specific stretches that work the iliotibial band tendon.

Many athletes “play through the pain”, not realizing they can beat the early stages. If you suspect jumper’s knee, come into Knoxville Spine and Sports; we can diagnose and help treat your injury. We’ll provide a comprehensive rehabilitation or physical therapy program that focuses on increasing overall range of motion, strength, and flexibility. We will most likely also utilize laser therapy to assist in healing. The laser will increase the healing rate in damaged tissue, decrease the inflammatory process, as well as relax tight and taut muscles. If we catch it early enough, at Stage 1 or 2, treatment can be conservative and there is excellent prognosis for a full recovery to get you back out on the court in no time.

Let Dr. Bert Assist In Your Recovery

As a Certified Chiropractic Sports Physician, Dr. Bert is well-equipped to successfully diagnose, treat, and help you progress to a level of optimal performance. Give us a call to set up an appointment today!

Plantar Fasciitis: Prevention and Treatment

Plantar Fasciitis: Prevention and Treatment

Pretty soon here in Tennessee, it will be springtime and you’ll be ready to run in the great outdoors.

Repeated stresses like running can create the painful foot condition known as plantar fasciitis. The plantar fascia tendon runs along the arch of the foot and essentially aids to connect your heel bone to your toes; it’s what helps gives your foot its arch support. Repeated stresses can often cause microtears in the band. It can also become inflamed, strained, and tight. Since this tendon helps maintain the arch of the foot and functions to absorb foot impact forces, you will likely feel a pulling sensation or even a sharp burning pain when you run. Some people even feel it when they take their first few steps after getting out of bed in the morning or after sitting for a long period of time. Unfortunately, if you have flat feet, the problem worsens, and wearing shoes with little to no arch support will only exacerbate the problem.

Plantar fasciitis can also be common in people who have naturally high arches or people who roll their feet inward when they walk (called excessive pronation). The problem can be exacerbated if you are overweight or you stand or move on hard surfaces for long periods of time. Plantar fasciitis is very common among middle-aged people, but can occur in younger people, and can happen in one or both feet.

Tendon issues like this certainly won’t disappear overnight, but there are many preventative measures you can take to alleviate the problem or at least reduce the pain. First, wear proper shoes that give you arch support, cushioning for the sole of the foot, and plenty of toe wiggle room so your foot is not cramped all day. It is also important to vary your exercise routine; if you have heel or arch pain, don’t run every day. Mix it up to take some of the load off that tendon.

Treatment Options For Plantar Fasciitis

Ultimately, addressing the pain early is key to successful treatment and prevention of further injury.

If we determine you have plantar fasciitis, we offer a variety of treatment modalities, including chiropractic care, Active Release Technique (ART), laser therapy, deep soft tissue massage, and dry needling. We’ll recommend a proper at-home care program as well. This will most likely begin with the simple RICE method of rest, ice, compression and elevation. We will suggest a stretching and mobility program as well to work towards increased flexibility in your calves and mobility in your ankles. We commonly suggest using a lacrosse or tennis ball at home to continue to try and release some of the tension in that tendon.  If you have structural or functional gait issues like high arches, flat feet or over pronation, we might recommend personalized custom orthotics to wear inside your shoes to relieve pressure.

Schedule A Consultation With Your Knoxville Chiropractor

If you’re experiencing foot pain, come see us at Knoxville Spine and Sports.

Dr. Bert will have you back on your feet in no time!

Common Injuries: Baseball Season

Baseball Injury Treatment in Knoxville

Take me out to the ballgame! It’s finally springtime in Knoxville, and that means baseball season is here! Baseball diamonds are filling with athletes of all ages: young ones play tee ball, middle and high school age kids play on school teams, and adults play both in professional leagues and recreational traveling teams. Baseball is known for several common injuries, many of which are overuse injuries. Knowing about such injuries, being proactive with training, and taking care of your body is key to avoiding such injuries.

Here are a few of the more common injuries we see from the baseball diamond:

· Muscle pulls and tears can occur when players exhibit sudden bursts of speeds running around the plate or running in the outfield, particularly without proper conditioning and warm-up exercises.

· ACL injuries typically occur when the knee is impacted from the front or rear, while MCL injuries occur with knee side impacts. Ankle sprains are also very common when overtaxing the joint or pivoting or changing direction.

· Upper body shoulder injuries are very common with frequent overuse in throwing or even direct hits to the shoulder. In particular, UCL (ulnar collateral ligament) injuries are common in baseball pitchers as they are continually throwing and pitching the balls.

· Rotator cuff tears are very common in pitchers due to repetitive injury to the shoulder area that causes the tendons to wear down over time.

If you begin to struggle with pain or weakness on the field, seek treatment before symptoms worsen. We commonly treat pitchers who experience elbow pain and catchers who deal with knee pain. The repeated motion of pitching and the continued squat stance of a catcher can both lead to overuse injuries. Chances are, if you continue to throw or continue to put yourself in those positions, symptoms will not simply “go away.” Prevention and early treatment can be key to avoiding worse injury.

As with any sport, it is key to also have a knowledgeable trainer who is very active in your training program and knows the aches and pains you deal with. You might think your symptoms are minor, but playing with a spinal injury or other injury can mean major damage down the road. A good trainer will always make sure you are medically evaluated and have been cleared before you return to play.

Proper conditioning and correct movement mechanics are also very important when it comes to preventing injury. At Knoxville Spine and Sports, our staff is experienced in a variety of training protocols and proper biomechanics. We work with all levels of athletes to teach proper conditioning to minimize and often completely avoid injury. We can work with you on necessary strengthening exercises and stretching movements and can speak with you about any injury concerns or predispositions you may have.

Centrally located in Knoxville, we are in close proximity to numerous schools and other sporting organizations. Let us help with all your injury prevention and care. Before the first pitch is thrown, come see us!

Proper Footwear Is Important!

Proper Footwear to Prevent Injuries

If you participate in a sport that encourages sport-specific shoes, it’s a given you will wear those sport-specific shoes. Soccer players wear cleats and Olympic lifters typically wear Oly lifting shoes. If you are active on any level, you’re an athlete, so proper footwear is vitally important!  Especially if you’re struggling with any sort of foot (or even back) pain, wearing a solid, well-supported pair of shoes can be key in lessening or even eliminating that pain.

As you’re searching for shoes, there are a few general rules of thumb. These few tips can help ensure you end up with a pair of shoes that will help rather than hurt. As you rummage through shoe stores, don’t be shy about picking up shoes and seeing if they pass these few tests:

  • Rigid heel counter – if you squeeze the sides of the heel of the shoe, you want to be sure that there is a significant amount of stability in that heel. If the heel portion of the shoe collapses in between your fingers, that’s one mark against that particular pair.
  • Torsional stability – hold the shoe in both hands and twist the shoe (much like you would twist if you’re wringing out a towel). A quality, supported shoe will not allow for much twisting.
  • Proper point of flexion – attempt to bend the shoe in half. A stable shoe will flex at the end of the laces rather than completely folding in half or even rolling. If the shoe flexes at the end of the laces, you’re good to go.

A few more specifics to aid in your search for proper footwear:

Make sure the toe box of the shoe matches your foot and that you choose a shoe with the proper width. If the shape of your toes doesn’t match the shape of the toe box at the front of the shoe, you will be more prone to issues. Typically, shoes are either straight lasted or curved lasted. Make sure you select a shape that correlates with the shape of your foot. Curve lasted shoes promote more pronation, so if you tend to overpronate, you would benefit more from a straight lasted shoe.

Check out the drop of the shoe – this is the ratio between the forefoot of the shoe and back of the heel. For example, running shoes can have a higher drop to keep the runner in a more forward position while shoes designed for CrossFit activities tend to have a lower drop to encourage the athlete to stay back on their heels in movements.  If you struggle with tight calves, tight Achilles tendon, lack of ankle dorsiflexion, or full knee extension, you may be more comfortable in a higher drop shoe.

Though there can be a break in period with new orthotics in new shoes, a new pair of shoes will fit comfortably out of the box. Essentially, there should be no “break in” period.


While these are some good pointers, it is always best to have your foot measured and sized for shoes. This will ensure your shoes fit properly, and, if you visit a store that specializes in fitting, they will be able to observe your gait and suggest specific types of shoes.

There are a few local stores that provide such sizing and athlete-specific fittings. They can measure your foot and observe your gait in order to suggest a shoe that may work best for your foot mechanics. They will also take into consideration any suggestions or information from your doctor or physical therapist. In specific, Runners Market is a prime local business that will work with you to find a shoe that suits you best. Their return policy is top-notch due to the fact they consider every case one at a time. If you aren’t satisfied with your purchase, they will work with you to make sure you are satisfied. They’ve been in business for 23 years and certainly do a fantastic job of making sure their customers have shoes that are perfect for them. Shopping locally is the way to go, especially when it comes to individualized attention! Call them or check out their website for more details:

At the end of the day, don’t sacrifice comfort and proper mechanics for fashion! If you have questions regarding proper foot mechanics or how you can find a shoe that works best for you, don’t hesitate to contact us!

Chiropractic Care for Competitive Swimmers

How Chiropractic Care Benefits Competitive Swimmers

Tennessee pools are ready for competitive swimming this season, and we want to remind you that competitive swimmers can greatly benefit from chiropractic care. Chiropractic care is designed to keep the body in overall peak condition by maintaining spinal alignment. When the spine is aligned, muscle imbalances are less likely to become an issue. The key to this care, however, is consistency of treatment and consistent at home performance of the exercises we teach.

There is a tendency among swimmers to experience overextensions in the lower back and neck due to various swimming strokes. Shoulder injuries are also common among swimmers due to the repetitive nature of the sport. With proper mechanics and preventative chiropractic care, such injuries can typically be avoided.

At Knoxville Spine and Sports, we will address the entire spine and overall spinal alignment. Dr. Bert will complete a comprehensive evaluation, noticing any imbalances or weaknesses which may predisposition the swimmer to injuries. Once we determine injuries or potential injuries, we will design a treatment plan that is unique to you and your needs. We will use a variety of modalities as necessary; these may include dry needling, active release technique, active isolated stretching, deep soft tissue massage, or even myofascial cupping with movement.

We also work with our athletes to develop strengthening plans specific to their sport. Swimmers who struggle with shoulder injuries or weaknesses may need a strengthening plan focusing on the rotator cuff musculature or may need to work on stretching and opening up their pectoralis muscles. Regardless of the needs of the swimmer, we will work specifically with them to design a plan to get them back to normal. We can also work with the swimmer on proper swimming technique to prevent future injury.

Even though swimming is considered a lower impact sport, swimmers are still susceptible to injuries as with any other sport. The different swim strokes (freestyle, backstroke, breaststroke and butterfly) all produce different injuries of the shoulders, hips, back, neck and knees. As an athlete, you can’t maintain peak condition while you have an injury. Don’t be one of those athletes who “works through the pain”. If you do that, your neck, back or shoulder injury will only worsen, and one day, you may not be able to swim at all. Come into Knoxville Spine & Sports and we’ll have you back in the pool in no time. We see swimmers of all ages—from teenagers to competitive adult athletes.

We are Together for Health and are looking forward to helping to prevent or treat your injuries from the pool!