Conditions Treated

At Buhler Athletic and Human Performance Clinic, we offer generalized explanations and A.M.I.T. ® explanations for common musculoskeletal conditions treated.

Man and Woman Running Together

Acute Vs Chronic Conditions

A.M.I.T. ® Explanation

Acute injuries are injuries or symptoms occurring under six weeks in duration.

Chronic conditions are any injuries or symptoms present for six weeks or longer.

If an acute injury is not corrected within six weeks of occurrence, the central nervous system if forced to adapt other tissues to protect the injured or symptomatic tissue. Eventually, the adapted tissues can become the next site for injury or symptom. A question that must be asked with any symptom; is the problem at the symptom site or is the symptom presenting the site of adaptation?

Acute injury treatment is directed at the site of injury. Chronic conditions often require treatment somewhere else in the body, which is always the area of an old injury. Unless old injuries are treated, the symptomatic area will never heal.

Sprains and Strains Conditions

Type One Sprain/Strain

Minimal disruption tissues (1-10%), minimal pain, minimal swelling. Treatable.

Type Two Sprain/Strain

Partial tearing of tissues (11-50%), some hemorrhaging, marked pain and swelling. Treatable.

Type Three Sprain/Strain

Severe tearing and possible rupture (51-100%), marked dysfunction, visible deformities, surgical case.

A concussion is a traumatic brain injury that alters the way your brain is able to function. Brain injuries occur when an external mechanical force causes brain dysfunction.

Causes of brain injuries may include falls, vehicle-related collisions, violence, sports injuries, explosive blasts, or other combat injuries. More common causes are mini-traumas in sports, like football or soccer.

Symptoms of concussions may include headache or feeling pressure in the head, temporary loss of consciousness, difficulty with balance, confusion, slurred speech, nausea, or fatigue.

Symptoms of brain injuries may include sensitivity to light or sound, mood changes, dizziness, difficulty sleeping, loss of coordination, seizures, dilation of one or both pupils, weakness, or numbness in fingers and toes.

A.M.I.T. ® Explanation: There are two primary parts to the human skull: the facial made up of 15 bones, and the cranial vault, which consists of 8 bones. They are separated by small cracks called sutures. Historically, it has been felt these sutures fuse at a very young age; however, these sutures are still visible on a dry bone skull specimen in older people, indicating the sutures are not fused. There is a large body of evidence in the field of osteopathy focusing on correcting restrictions in the motion within the cranial sutures. The sutures allow the cranial bones to move each time we breathe. This is the foundation of “Cranial Sacral Therapy” used by Osteopaths. When these sutures are jammed due to trauma, the brain and cerebral fluid flow are adversely affected and are the cause of many symptoms associated with concussions. In this situation, cranial release “Nasal Specific” therapy is the most effective corrective treatment, leading to rapid recovery.

Learn more on our Nasal Specific Cranial Work page.

A.M.I.T. ® Explanation: has a high degree of success in reversing the effects of concussion.


A cervicogenic headache is caused by a problem in the neck.

Causes may include: multiple traumas to the neck, inflammation of the facet joints or degenerative disease.

Symptoms may include: steady, non-throbbing pain at the back and base of the skull, a sensation of a tight band around the head, pain radiating up the neck into the skull, or neck stiffness.

A.M.I.T. ® Explanation: Any injury to the joints (facets) and muscles of the neck, which may cause joints to inflame and muscles to become inhibited or dysfunctional. Once damage has occurred, the body attempts to stabilize the neck by tightening the muscles supporting the head. This constant tension restricts circulation and lymphatic drainage leading to pain and inflammation.

Tension Headache

A tension headache is mild to moderate pain in the head; often a feeling like a tight band around the head is described. This is due to constant tightness of the muscles attached to the back of the head and into the neck and shoulders.

Causes may include: neck trauma, constant emotional or physical stress, problems with teeth/jaw, or low-grade sinus inflammation triggers.

Symptoms may include: dull, aching head pain, sensation of pressure across the forehead and back side of the head, or tenderness in scalp, neck, and shoulder muscles.

Migraine Headache

A migraine headache is throbbing or pulsing sensations in one area of the head. Early symptoms include aura and blurred vision occurring before or during migraine headaches. One may experience nervous system symptoms, flashes of light, sound and light sensitivity, nausea and vomiting, blurred vision, lightheadedness, fainting, speech problems, or vision loss. Attacks, untreated may last from four to 72 hours.

Medically, the causes of migraine headaches are unknown and often involve many triggers.

A.M.I.T. ® Explanation: Migraine headaches are a more critical condition to define. Concussions, low blood sugar problems, toxic exposure, tooth/jaw problems and hormone imbalances are the most common causes, and can be managed conservatively using AMIT methods. Less common causes are a defect in the heart called Patent Foramen Ovale (PFO), in which a small valve in the heart of the developing fetus fails to close off after birth, or a dissected vertebral artery, which is usually set up by severe trauma to the cervical spine. Both of these conditions can be a warning the person could be suffering from the early signs of what is called “Dissected Vertebral Artery” and predisposed to a stroke. This type of headache is multi-factorial and may need medical referral. This is why it is so important to perform an initial examination on all new patients.

Neck Lateral

Neck Conditions

Neck PA

Neck pain is an irritation or damage causing neck, head, and upper shoulder pain. Usually feels dull, achy, and occasionally sharp with a possibility of radiating pain throughout the entire neck, into the upper shoulders and back.

Causes may include: trauma (whiplash), poor sleeping positions, and diseases like osteoarthritis or Rheumatic Fever.

Cervical dystonia, called spasmodic wryneck or torticollis, is a painful condition in which the neck muscles contract involuntarily, causing the head to twist or turn to one side. This condition can also cause the head to uncontrollably tilt forward or backward. It can occur at any age and is more common in women than men. Babies can be born with this condition.

Causes may include: certain reactions to drugs, trauma to the head, neck and upper shoulder injuries, or infections.

Symptoms are characterized by the head and neck being locked in a rotated and flexed position with severe neck pain radiating into the shoulders. For some, the pain can be exhausting and disabling.

A.M.I.T. ® Explanation: The muscles of one side of the neck have been traumatized causing muscle inhibition and the joints to be inflamed. The body pulls the neck in a certain direction, which decreases the stress on the injured tissues, in an effort to protect them.

Cervical disc herniation is when the center of the disc, called the nucleus, ruptures outside the disc. This may cause sharp or electrical pain into the neck, shoulder, arm and/or hands, along with numbness and muscle weakness. The symptoms may also be less intense such as pain the shoulder, elbow, wrist or hand.

Causes may include: trauma, aging, poor posture, or improper wear of the cervical discs due to muscle imbalances, usually caused by trauma to the neck.

A.M.I.T. ® Explanation: Discs herniated due to multiple traumas, chronic inflammation or muscular instability causing repetitive stress on the disc. This leads to a break down in the disc. Eventually the nucleus may rupture putting pressure against the nerve root.

A condition in which the neck is suddenly hyperextended or hyperflexed such as the trauma associated with rear-end or head-on auto collisions.

Pain may include: local or allover dull aching, local or allover sharp pain, swelling or weakness. Often the symptoms begin as sharp pain upon impact and evolve into a dull ache. Eventually after a few months, the patients may begin to develop arm, elbow or wrist pain, which does not respond to treatment.

A.M.I.T. ® Explanation: The muscles, discs, and joints in the neck are filled with complex nerve centers that assist in control of the head and neck. When these muscles and joints become injured or irritated, nerve centers cause the muscles of the neck to splint or tighten in an effort to protect from further injury. This situation leads to pain and restricted motion. The key is to normalize the joint and muscle function, which removes the source of the pain. This can occur rapidly using the A.M.I.T. ® methods.

Shoulder Conditions

A rotator cuff is a group of muscles and tendons that surround the shoulder joint, stabilizing the head of the upper arm bone in the socket of the shoulder. Severe injuries may require surgical repair.

Causes of rotator cuff injuries include sports injuries, lifting or pulling repetitive stress, or bone spurs.

Pain associated with a rotator cuff injury can present as a dull or deep ache in the shoulder, disturbed sleep, difficulty reaching behind the back, or arm weakness.

A.M.I.T. ® Explanation: Rotator cuff syndrome is caused by an injury to one or more of the four shoulder muscles: Supraspinatus, Infraspinatus, Teres Minor, or Subscapularis (SITS) muscles. When these muscles are injured, their attachments, or entheses, become inflamed and cause pain any time the muscle is stressed. The A.M.I.T. ® method is the most efficient way to correct this condition. If a patient does not respond to therapy within two to three visits, the rotator cuff is torn requiring surgical repair.

Shoulder Impingement is a common cause of shoulder pain. It occurs when there is impingement of tendons or bursa in the shoulder from bones of the shoulder.

Causes of shoulder impingement may be any overhead activity of the shoulder, especially repeated activity.

Pain may include inflammation of the rotator cuff tendons, weakness of shoulder muscles, difficulty reaching up behind the back, or pain with overhead use of the arm.

A.M.I.T. ® Explanation: This is a severe and chronically painful condition in which the patient is unable to move their shoulder and arm past 90 degrees. It can last three months or longer and then completely go away. Some patients try surgery as a last resort yielding varying degrees of success. Our clinical research suggests this condition is caused by a number of factors. Muscle inhibition of the shoulder due to multiple injuries lead to a major functional imbalance, causing the muscles to become tight and painful when activated. The body restricts the motion to protect itself. Another common factor is extension and restriction in the motion of the base of the skull on the spine causing stress on the Vagus and Spinal Accessory nerve. These factors can be corrected using the A.M.I.T. ® methods.

Biciptial Tendonitis is an inflammation of one of the tendons that attach the muscle (biceps) on the front of the upper arm bone (humerus) to the shoulder joint. The inflammation is usually along the groove where the tendon passes over the humerus to attach above the shoulder.

Causes may include overuse in throwing motions, inflammatory conditions, infections, or injury.

Pain may include: shoulder pain down the front of the arm, or tenderness where bicep meets the shoulder.

A.M.I.T. ® Explanation: The tendon of the long head of the biceps runs through a groove at the top part of the shoulder. A strong tissue holds this tendon in the grove, allowing for smooth gliding of the tendon when the arm is moved. This tendon may become inflamed leading to bicipital tendonitis; however, the primary cause of this condition is inhibition and inflammation of the attachments of muscles connecting close to this groove. The pectoralis major, latissimus dorsi, teres major, teres minor, subscapularis, and supraspinatus can all be involved. In addition, pain can also be coming from a referral from the cervical spine. Once the source of the pain is established, the condition can be correct using the A.M.I.T. ® method.

Frozen shoulder is characterized by stiffness and pain in the shoulder joint. One may experience difficulty lifting the arm above 45 degrees.

Causes may include: thickening of connective tissue making up the shoulder joint, tightening of connective tissue, flexion restriction of the head on the spine, injury to multiple shoulder support muscles, or damage to connective tissue. Patients may wake up one morning and find they cannot move their shoulder.

Pain associated may develop in stages: painful stage, frozen stage, or thawing stage. For some, the pain worsens at night.

A.M.I.T. ® Explanation: This is a severe and chronically painful condition in which the patient is unable to move their shoulder and arm past 45 degrees. Our clinical research suggests this condition is caused by a number of factors. Muscle inhibition of the shoulder due to multiple injuries lead to a major functional imbalance, causing the muscles to become tight and painful when activated. The body restricts the motion to protect itself. Another common finding is extension and restriction in the motion of the base of the skull on the spine. This is caused when the small suboccipital muscles are inhibited due to upper neck trauma.

Acromioclavicular Sprain or AC joint sprain is an injury to the ligament holding the acromioclavicular joint together.

Causes of an AC joint sprain are usually due to a fall onto an outstretched arm.

Pain characterized may include: localized or widespread pain at the end of the collar bone, pain moving the arm above the shoulder, swelling, or lump if joint has been disrupted.

A.M.I.T. ® Explanation: The AC joint is the acromial process of the scapula and clavicle bone connection at the top of the shoulder. This sprain occurs when trauma injures the ligaments holding the joint together. During the trauma, the clavicle is jammed and fixated, and the muscles that control the motion become inhibited. This interferes with the normal function of this joint, leading to pain. Manipulation to restore AC joint motion and A.M.I.T. ® muscle therapy to re-establish function can lead to rapid correction and pain-free motion.

Shoulder PA

Elbow Conditions

Elbow Medial

Tennis elbow is a painful condition occurring when repetitive motions of the wrist and arm overwork tendons in the elbow.

Causes are due to overuse and muscle strain. Repeated motions and stress to the tissues may result in a series of tiny tears in the tendons attaching the forearm muscles to the outside of the elbow. Activities leading to causes may include golf, racket sports, throwing sports, weight lifting, or other wrist bearing activities.

Pain associated may radiate from the outside of the elbow into the forearm and wrist. It may be difficult to shake hands, turn a doorknob, or hold a cup.

A.M.I.T. ® Explanation: Pain that occurs on the outside of the elbow is caused by inhibition of the wrist extensor muscles, inflammation of the periosteal tendon insertions (enthesis) of the extensor muscles (extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, and extensor digitorum) or over development of the anterior shoulder muscles. Correction of this condition is accomplished by reactivating the extensor muscles and exercising the posterior shoulder muscles.

Golfer’s elbow is similar to tennis elbow; instead the pain occurs on the inside of the elbow, where the tendons of the forearm muscles attach to the bony bump on the inside of the elbow.

Causes are due to damage of the muscles and tendons controlling the wrist and fingers, usually related to excessive or repetitive stress. Activities leading to causes may include golf, racket sports, throwing sports, weight lifting, or other wrist bearing activities.

Pain may include: tenderness on inner side of elbow, stiffness or pain making a fist, weakness in hands or wrists, or numbness and tingling into the ring and little fingers.

A.M.I.T. ® Explanation: Pain occurring on the inside of the elbow is caused by inhibition of the wrist flexor muscles, or over development of the anterior shoulder muscles. Correction of this condition is accomplished by reactivating the flexor muscles and exercising the posterior shoulder muscles.

Wrist Conditions

Carpal Tunnel Syndrome is a progressively painful hand and arm condition caused by a nerve pinched in the wrist.

Carpal tunnel syndrome is caused by compression of the median nerve. The median nerve runs from the forearm, through a passageway in the wrist (carpal tunnel) to the hand. Anything that crowds irritates or compresses the median nerve can lead to pain.

Pain may include tingling or numbness in fingers and hand, pain radiating or extending from the wrist to the arm and shoulder, or down into palm and fingers, or a sense of weakness in hands.

A.M.I.T. ® Explanation: This condition is caused by falling on the hands, jamming the bones in the wrist, repetitive stress, or trauma to the wrist. This leads to compression of the median nerve by the retinaculum supporting the wrist or the inhibition of the pronator quadrates muscle. The symptom may also be due to irritation of nerve roots in the cervical spine. Manipulating the cervical spine or carpal bones can cause a dramatic change in symptoms without surgery. Correction is achieved by manipulating the bones back into alignment or reactivating the pronator quadrates muscle taking the pressure off the nerve.

De Quervain’s Tenosynovitis is a painful condition that affects the two tendons located on the thumb side of the wrist.

De Quervain’s Tenosynovitis may be caused by repeated movement leading to the tendon sheath becoming inflamed and thickened.

Pain may include: pain in wrist, pain at base of thumb, swelling near base of thumb, or difficulty grasping or pinching.

A.M.I.T. ® Explanation: This condition may be caused by multiple traumas to the thumb leading to joint fixation and muscle inhibition. It can be corrected by reactivating the muscles and manipulation of the thumb.

Wrist sprains can be caused by sudden injuries.

Causes of sprains or strains may vary.

Pain may include dull aching or various degrees of pain and tenderness.

A.M.I.T. ® Explanation: Damage to any of the muscles that cross the wrist, or to any of the ligaments that support the wrist, can lead to pain. Jamming of the carpal bones by a fall landing on the extended wrist and hand is the most common cause. Manipulating the bones back into proper alignment creates immediate relief.

Wrist AP

Spine Conditions


Thoracic outlet syndrome occurs when the blood vessels or nerves in the space between the collarbone and first rib become compressed. This can cause pain in the shoulders and neck, and numbness in the fingers.

Causes may include physical trauma from a car accident, repetitive injuries from job-related activities, sports injuries, certain anatomical defects, or pregnancy.

Pain may include: pain or aches in the neck, shoulder or hand, weakening grip, numbness or tingling in arms or fingers, wasting in the fleshy base of thumb, neurogenic thoracic outlet syndrome, vascular thoracic outlet syndrome, or nonspecific-type thoracic outlet syndrome.

A.M.I.T. ® Explanation: This condition is caused by trauma to the upper rib cage, clavicle and lower cervical spine. This leads to a restriction in the motion of the 1st and 2nd ribs, causing the muscles to tighten and compress vascular elements and nerves. Correction is accomplished by manipulating the ribs, upper dorsal and cervical spine, and reactivating the inhibited muscles.

A herniated disk refers to a problem with one of the cushions (disks) between the individual bones (vertebrae) stacking to make up the spine. A spinal disk is like a jelly donut, a softer center within a tough exterior. Sometimes called a “slipped” or “ruptured disk”, a herniated disk occurs when some of the softer “jelly” pushes through a crack in the tougher exterior.

Causes may include work or sports-related, stress, age-related wear and tear (disk degeneration), misuse, or compensation of muscle groups to perform an activity.

Pain may include: pain radiating from the low back into the gluteal area into the leg and foot, numbness or tingling, weakness, muscle loss, or compensation.

A.M.I.T. ® Explanation: Multiple back injuries, sitting for long periods of time, lack of exercises, chronic inflammation, muscle inhibition, and many more Although a disc may be herniated, it does not mean it is the source of pain. The severity of the herniations will determine the degree of pain and dysfunction, and whether surgery is needed. Most disc herniations can be managed successfully with the A.M.I.T. ® method.

Sciatica refers to pain radiating along the path of the sciatic nerve. The sciatic nerve branches from the lower back through the hips and buttocks and down each leg. Typically, sciatica affects one side of the body.

Sciatica is caused by the nerve becomes pinched, usually by a herniated disk in the spine or bone spur (bone overgrowth) in the vertebrae. On rare occasions, the nerve may be compressed by a tumor or damaged by a disease, like diabetes.

Pain may include: discomfort along nerve path, mild ache, a sharp or burning sensation, numbness, tingling, muscle weakness in affected leg or foot, or pain in one part of the leg numbness in another.

A.M.I.T. ® T Explanation: This is a condition in which a group of nerves coming off the lower back and sacrum merges to form a large nerve, called the sciatic nerve. When inflamed, the sciatic nerve can cause pain deep to the buttock, hamstring, knee, lower leg, or foot. The root cause is found in the lower back and deep gluteal area. The nerve can be irritated by a bulging disc or problems with the piriformis muscle. It can be aggravated by sitting for long periods of time on a wallet. Correction includes spinal manipulation, muscle reactivation, exercises, and frequent decompression.

Scoliosis is a sideways curvature of the spine occurring most often during the growth spurt right before puberty. Most cases of scoliosis are mild.

Scoliosis may be caused by birth defects affecting the development of spinal bones, neuromuscular conditions like “cerebral palsy or muscular dystrophy”, or injuries and infections of the spine.

Symptoms may include: uneven shoulders, one shoulder blade appearing more prominent than the other, uneven waist, or difficulty breathing.

A.M.I.T. ® Explanation: Scoliosis can be caused by a congenital wedging of a vertebral body making the spine laterally bend. This is called functional scoliosis and there is not a cure. Scoliosis may also be caused by a short leg or muscle inhibition. If related to a short leg, a heal lift will correct the problem. If it is related to functional muscle inhibition, the A.M.I.T. ® method will allow the spine to balance out.

Hip Conditions

Hip dislocation or dysplasia is the term for a hip socket that doesn’t fully cover the ball portion of the upper thighbone.

Most people are born with hip dysplasia, although some won’t develop symptoms until later in life.

Pain may include deep pain in the front of the groin, pain in the side or back of the hip, or mild limping.

A.M.I.T. ® Explanation: Dislocations can be corrected using manipulation of the hip to re-establish the joint function. Dysplasia can be managed through muscle reactivation and exercising to maintain the integrity of the muscle system to compensate for the hip condition. Surgery may eventually be needed as a person ages. The earlier the A.M.I.T. ® method treatment is initiated the longer it will take before surgery is necessary.

Hip sprains and strains are common injuries sharing similar signs and symptoms. A sprain is a stretching or tearing of ligaments, the tough bands of fibrous tissue connecting bones in the joints.

Causes may include: falling, a direct blow to the muscle (a contusion), overstretching, or overuse causing muscle fibers to tear.

Pain may include pain over the injured muscle, swelling, or loss of strength and mobility in the muscle.

A.M.I.T. ® Explanation: When the hip is traumatized, muscles may become overloaded and inhibit to protect from more serious injury. Inhibited muscles do not contract in appropriate ways. From that point on, any time the muscle is loaded it “gives way” in a weak response. If it continues to be stressed, the pain will result in an effort to protect the muscle from more injury. The body will not allow motion it cannot stabilize, resulting in motion restriction for that plane of motion. Stretching the muscles to increase motion may only set up conditions for more severe injuries.

Hip Bursitis is a painful condition affecting the small fluid-filled pads, called bursae, which act as cushions along with bones, tendons, and muscles near the joints. Bursitis occurs when bursae become inflamed.

Causes of hip bursitis are repetitive motions or positions that irritate the bursae around a joint.

Pain may include: feeling achy or stiff, pain with movement or pressure, or an area appearing swollen and red.

A.M.I.T. ® Explanation: Inflammation of the bursa in the area of the hips. There are multiple bursa in the hip such as Ischial-Gulteal Bursa, Trochanteric Bursa, and Iliopsoas Bursae. The primary causes of pain are muscles attached to the hip that are injured or inhibited. Forcing injured or inhibited muscles to work may create pain and reduced motion, increasing degenerative changes.

Osteoarthrosis is the most common form of arthritis, often referred to as “wear-and-tear arthritis”.

Causes occur when the protective cartilage on the ends of the bones wears down over time.

Pain may worsen with time and can damage any joint in the body. Usually affects the joints in the hands, neck, lower back, knees, and hips.

A.M.I.T. ® Explanation: A loss of muscular support and increased inflammation leading to the breakdown of the articular cartilage of the hip, resulting in the formation of bone spurs, pain, and decreased function. One of the most common causes is long-standing muscle inhibition of the muscles supporting the hip joint. Another common cause of this condition is the consumption of soda pop, GMO foods, vegetable oil, high fructose corn syrup, and hybridized wheat.

Piriformis Syndrome is an uncommon neuromuscular disorder. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. It stabilizes the hip joint, lifting and rotating the thigh away from the body.

Piriformis syndrome is caused when the piriformis muscle compresses the sciatic nerve.

Pain may include tingling, or numbness in the buttocks, pain extending down the leg, sciatica after sitting for long periods of time, pain walking, or running. Most cases of sciatica, are not due to piriformis syndrome.

A.M.I.T. ® Explanation: The piriformis muscle attaches to the greater trochanter (hip bone) and fans out to attach to the lateral side of the sacrum. When this muscle becomes chronically tight, it can cause pressure on the sciatic nerve, leading to symptoms associated with sciatica. In a small percentage of patients, the sciatic nerve runs through the piriformis muscle, instead of under it. Inhibition of this muscle is the most common cause of irritation, which is easily corrected using the A.M.I.T. ® method. Another common cause is sitting on a wallet for extended periods of time.

Iliotibial Band Syndrome is said to occur when the thick fascial band that extends from the outside of the pelvic bone to the outside of the tibia (iliotibial band) becomes tight and rubs against the outer portion of the femur.

Causes may include muscle tightness or weakness, poor alignment, or compensation and adaptation of connective tissue and muscles. Distance runners are most susceptible.

Pain may include swelling and stiffness of the lateral side of the hip, thigh, and knee. These areas may develop redness and warmth to the touch, weakness or instability, popping or crunching noises, inability to fully straighten the knee or any type of weight-bearing activity-causing pain.

A.M.I.T. ® Explanation: Recent research shows that friction due to the band rubbing against the knee does not cause this condition. The Iliotibial (IT) band is a thick band of tissue that runs down the side of the thigh attaching into the lateral side of the knee. It attaches to the tensor fascia lata muscle, which attaches into the anterior lateral side of the ilium to the lateral aspect of the knee. The band is anchored by the gluteus maximus muscle along the posterior margin. IT band syndrome is caused when these two muscles become inhibited and can be easily corrected using the A.M.I.T. ® method.

Thigh Lateral

Knee Conditions

Knee Lateral

The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) bridge the inside of the knee joint, forming an “X” pattern that stabilizes the knee front-to-back and back-to-front.

The posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL) bridge the inside of the knee joint, forming an “X” pattern that stabilizes the knee front-to-back and back-to-front.

Causes of ACL sprains may include a sudden stop, twist, pivot, or change in direction at the joint, hyperextension, or a direct impact. The most common cause of an ACL rupture is the traumatic force being applied during twisting motion and sidestepping of landing from a jump.

Causes of PCL sprains may include a direct impact on the front of the knee, such as landing hard on a bent knee during sports.

A.M.I.T. ® Explanation: During an ACL or PCL sprain, the quadriceps muscles are overloaded and inhibited. Often times the gastrocnemius and popliteus muscles are also inhibited. This is why so many patients have difficulty during rehabilitation engaging their quadriceps. If these muscles are inhibited due to multiple knee traumas, the patient will be more susceptible to cruciate ligament injuries.

The Medial Collateral Ligament (MCL) supports the knee along the inner side of the leg. The MCL can be torn by a direct sideways blow to the outside of the knee or lower leg.

Causes of MCL sprains may include a severe knee twist, particularly when a fall twists the lower leg outwards, away from the upper leg.

A.M.I.T. ® Explanation: When the vastus medialis muscle group has become inhibited the knee loses medial stability. As the vastus medialis muscle group continues to activate, it tends to put the knee in a valgus or “knocked knee” position. This places more stress on the MCL and makes it susceptible to rupture with later knee trauma. If any of these muscles have been inhibited through prior injuries, people will be susceptible to tearing these ligaments. It may also lead to the kneecap tracking improperly, which is why having an A.M.I.T. ® evaluation before having a surgical release is recommended.

The Lateral Collateral Ligament (LCL) supports the outer side of the knee. It is the least likely knee ligament to be sprained.

Causes of LCL sprains are due to a blow to the inside of the knee.

A.M.I.T. ® Explanation: When the vastus lateralis muscle group has become inhibited the knee loses lateral stability. As the vastus medialis muscle group continues to activate it tends to put the knee in a varus or “bull legged” position. This places more stress on the LCL and makes it susceptible to rupture with medial knee trauma. When force is applied from the lateral side of the knee it overloads the gracilis, Sartorius, semimembranosus, and semimembranosus muscles. This leads to medial instability of the knee, even after the ligaments have healed.

A meniscus tear is one of the most common knee injuries. Each knee has two menisci C-shaped pieces of cartilage, which act as a cushion between the shinbone and the thighbone.

Causes may include any activity requiring someone to forcefully twist or rotate the knee, especially when putting the pressure of full weight on it.

Pain may include: a popping sensation, swelling or stiffness, pain when twisting or rotating the knee, difficulty straightening the knee fully, or experiencing what feels like a block to the movement of the knee, as if the knee were locked in place.

A.M.I.T. ® Explanation: Defect of one or both of the fibrocartilage circular menisci of the knee that properly position and support the knee, causing a small painful click inside the knee and joint line tenderness. Surgical repair is the only option to treat a torn meniscus. Conservative care only increases the likelihood of more severe tearing in the future.

Chondromalacia Patella is a term indicating damage to the cartilage under the kneecap, also referred to as Patellofemoral Pain Syndrome. It is characterized by softening of the cartilage surfaces.

Causes may include overuse or repetitive stress on the knee joint, poor control of the muscles, when muscles around the hip and knee don’t function optimally to maintain proper tracking of the kneecap, or trauma to kneecaps, such as a dislocation or fracture.

Pain may include a dull and aching pain in the front of the knee, pain walking up or downstairs, pain kneeling or squatting, or pain sitting with a bent knee for long periods of time.

A.M.I.T. ® Explanation: When muscles supporting the knee joint become inhibited from the accumulation of injuries, they no longer support the joint. The stress of weight-bearing is increased on the cartilage and other connective tissues. This creates a chronic inflammatory and degenerative process. If there is the addition of long-standing nutritional deficiencies related to cartilage repair, the cartilage surfaces begin to soften and degenerative processes are increased. Frequent consumption of soda pop can increase joint degeneration as well.

Jumper’s Knee (patellar tendinitis) is an injury affecting the tendon connecting the kneecap (patella) to the shinbone (tibia). The patellar tendon helps the muscles extend the knee to kick a ball, run uphill, and jump up in the air.

Causes may include: overuse, repeated stress on the patellar tendon creating tiny tears in the tendon. When tears become numerous they cause pain from inflammation and a weakening of the tendon structure. This is most commonly seen in athletes whose sports involve frequent jumping, such as basketball and volleyball. This condition is the primary reason athletes retire from the sport.

Pain may include: pain in the section of the patellar tendon between the kneecap and the area where the tendon attaches to the shinbone, progressive pain in the area, pain when climbing up and downstairs, pain present as beginning a physical activity, or pain after an intense workout.

A.M.I.T. ® Explanation: This condition is caused by muscular imbalances of the quadriceps complex, gluteus maximus muscle group, and the gastrocnemius muscles. Historically, the quadriceps have been made up of four muscles: vastus medialis, vastus lateralis, vastus intermedius, and rectus femoris. We’ve discovered these muscles are actually divided into thirteen muscles: vastus medialis, upper, middle, lower, and oblique divisions, as is the vastus lateralis. The vastus intermedius is divided into two divisions, the medial and lateral divisions. The rectus femoris is divided into the straight head and reflected head. The last muscle is the small articularis genu. Each of these muscles has its own precise action. When these muscles become inhibited due to injury or overuse, their tendonous attachments become inflamed during the first six weeks following injury. After six weeks have lapsed, degenerative processes begin. The pain centers in the tendon/bone attachment, called the enthesis, generating intense pain to unload the muscle and protect it from tearing. Due to the muscle’s inability to stabilize the kneecap, it does not tract properly and the condylar surface becomes inflamed and more prone to degenerative changes.

Ankle Conditions

An ankle sprain occurs when one rolls, twists, or turns the ankle in an awkward way. This can stretch or tear the tough bands of tissue (ligaments) that help hold the anklebones together. Ligaments help stabilize joints, preventing excessive movement.

Causes may include: when the ankle is forced to move out of its normal position, landing awkwardly on the foot after jumping or pivoting, walking or exercising on uneven surfaces, or a fall that causing the ankle to twist.

Pain may include: swelling and bruising, restricted range of motion, or pain when bearing weight on the affected ankle.

A.M.I.T. ® Explanation: During an inversion sprain, the lateral stabilizing ligaments are stretched and sustain a certain degree of tearing. Additionally, the peroneus longus, metatarsal, and cuneiform divisions, peroneus brevis, septal and fibular divisions, and the peroneus tertius muscles are injured and inhibited. Once these muscles are inhibited, the ankle loses its neurological control, causing instability and future ankle sprains.

Shin splints refer to pain along or just behind the shinbone (tibia), the large bone in the front of the leg.

Causes may include excessive force (overload) on the shinbone and connective tissue that attach the muscles to bone, running downhill, running on a slanted or tilted surface, running in worn-out footwear, engaging in sports with frequent start and stops, or physical training errors.

Pain may include tenderness and soreness along the inner part of the lower leg, mild swelling in the lower leg, or bruising. The pain can become debilitating and chronic.

A.M.I.T. ® Explanation: Shin splints are a complex problem found in all athletic activities, more commonly seen in patients who display over-pronation of the foot and ankle. Shin splints are divided into two types: anterior or posterior shin splints. We have determined there are two anterior types: tibialis anterior syndrome and anterior compartment syndrome. The posterior division has three types: medial tibial stress syndrome, posterior tibial syndrome, and posterior compartment syndrome. The cause of each occurs when the muscle attaching into these areas become inhibited. These include tibialis anterior, supinator and dorsiflexor divisions, tibialis posterior, tibial and fibular divisions, flexor hallucis longus, tibial and fibular divisions, extensor hallucis longus, interosseous and fibular divisions, and extensor digitorum longus medial and lateral divisions. These muscles attach to either the periosteum of the bone or the interosseous membrane. When any of these muscles become inhibited and stressed through athletic activities, they become inflamed and lose their ability to contract and relax under changing conditions, leading to pain at the attachment. In addition, the muscles cannot control concentric/eccentric control of the arch of the foot, allowing over-pronation to occur. This contributes to increased torque on the interosseous membrane.

Achilles Tendinitis is an overuse injury of the Achilles tendon, the band of tissue connecting the calf muscles at the back of the lower leg to the heel bone.

Causes may include an intense or repetitive strain of the Achilles Tendon.

Pain may include mild aches in the back of the leg or above the heel after running or other sports activity, episodes of severe pain after prolonged running, stair climbing or sprinting, or tenderness and stiffness in the morning.

A.M.I.T. ® Explanation: Irritation and inflammation of the Achilles tendon, which is made up of the medial and lateral Gastrocnemius and soleus muscles, resulting in pain 1-2 inches above Calcaneus/heel. When muscles are overloaded due to multiple factors, they become inhibited and cannot contract efficiently leading to an overuse condition and pain. If muscles are not reactivated neurologically, the tendinous attachments begin to break down and eventually rupture.

Ankle Lateral
Ankle Medial

Plantar Fasciitis is inflammation of a thick band of tissue, called the Plantar Fascia, which runs across the bottom of the foot and connects the heel bone to the toes. Plantar Fasciitis is one of the most common causes of heel pain.

Causes of Plantar Fasciitis are due to small tears in the fascia. Under normal circumstances, the Plantar Fascia acts like a shock-absorbing bowstring that supports the arch in the foot. If tension on the bowstring becomes too great, it begins to tear.

Pain may include: pain triggered or worsened within the first few steps after awakening, pain after long periods of standing or sitting, pain in the heel of the foot, or foot pain developing gradually throughout the day.

Causes of PCL sprains may include a direct impact on the front of the knee, such as landing hard on a bent knee during sports.

A.M.I.T. ® Explanation: The cause of this condition is inhibition of the primary arch support muscles (tibialis anterior, supinator and dorsiflexor divisions, tibialis posterior, tibial, and fibular divisions) of the foot. This leads to overstressing of the small flexor muscles of the toes and the plantar aponeurosis. Failure of the supporting muscles allows the foot to over-pronate, adding to the problem. This places all the stress of supporting the arch on the plantar aponeurosis and causes inflammation and break down.